b. Signs/Symptoms of Tension Pneumothorax.
Progressive respiratory distress.
(3) Subcutaneous emphysema. Refer to paragraph 1-11. In this case,
there is severe involvement of the entire chest, face, and neck. The area may appear
grotesque and/or bloated.
Pain on the affected side.
(5) The affected side will appear more prominent and move less. Air will
remain trapped within the pleural cavity on exhalation.
Breath sounds will be distant or absent on the affected side.
(7) Percussion reveals hyperresonance (exaggerated resonance on the
(8) Progressive distention of the abdomen that is not relieved by gastric
aspiration (removal of fluids from the stomach) and endotracheal intubation.
(9) Deep cyanosis (bluish discoloration of the skin caused by insufficient
oxygen in the blood).
c. Treatment of Tension Pneumothorax.
(1) Perform thoracentesis, if required. Thoracentesis is a method of
removing air or fluids by suction (aspirating) by surgical puncture of the chest wall into
the parietal cavity To perform thoracentesis, follow this procedure:
(a) Gather equipment according to local standing operating procedure
(b) Locate the proper site of entry by counting ribs. The site will be
high if you are removing air and lower if you are removing fluid. For air, the site of entry
is the medclavicular area of the second intercostal space. (The second intercostal
space is the space between the second and third ribs). To remove fluid, the site is the
intercostal space between the sixth and seventh ribs. To locate the specific ribs, count
backward from the twelfth rib (see figure 1-5).
Prep the skin with an antiseptic swab and drape with sterile towels.