Emergency War Surgery NATO Handbook: Part II: Response of the Body to Wounding: Chapter IX: Shock and Resuscitation

Needle Thoracentesis

United States Department of Defense

Needle Thoracentesis

Note: This procedure is applicable to the rapidly deteriorating casualty with a life-threatening tension pneumothorax.

1. Identify the second intercostal space, in the midclavicular line on the side of the pneumothorax.

2. Insert it 14 or 16 gauge needle into the skin and direct the needle just over (i.e., superior to) the top of the rib into the intercostal space.

3. Puncture the parietal pleura. If the patient has a tension pneumothorax, a rush of air will exit from the hub of the needle.

4. Prepare for a chest-tube insertion. The chest tube should be inserted at the nipple level anterior to the midaxillary line of the affected side.

5. Connect the chest tube to an underwater seal device or a flutter-type valve apparatus.

6. Obtain a chest X-ray.

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Operational Medicine 2001

Health Care in Military Settings

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