Chest Decompression

Method of Chest Decompression

• The traditional method of chest decompression involves identifying the second intercostal space.

• This method is used in both the hospital and pre-hospital settings.

• It is indicated when there is an obvious or suspected chest trauma and signs of tension pneumothorax and hemodynamic compromise.

"The traditional method is using anatomical landmarks...this identifies a spot just above the third rib and the second intercostal space."

Importance of Urgent Chest Decompression

• Chest decompression is crucial in cases where gas under pressure in the chest cavity is causing serious hemodynamic compromise.

• This most often occurs in major trauma situations, but can also happen as a result of medical interventions or spontaneously.

"Gas under pressure and causing serious hemodynamic compromise...more likely when you're positive pressure ventilating."

Indications for Chest Decompression

• Chest decompression should be performed when there is an urgent need for it.

• The procedure should be done quickly to address the hemodynamic compromise caused by tension pneumothorax.

• Ideal materials for the procedure include a dwell calf 90mm long 12 gauge, or a standard cannula.

"Need the inclination and you should do it quickly...ideally you'll have a dwell calf 90 millimeters long 12 gauge."

The Traditional Spot for Cannula Placement

• The traditional spot for cannula placement in chest decompression is the second intercostal space, just above the third rib.

• This spot is identified using anatomical landmarks, such as the angle of Louie and the midclavicular line.

• It is crucial to insert the cannula above the rib to avoid damaging blood vessels and nerves.

"The traditional spot is the second intercostal space...this is where we place the cannula."

Alternative Spots for Cannula Placement

• Since the traditional method may not work 50% of the time with a standard-sized cannula, alternative spots need to be considered.

• The alternative spot involves locating the fifth intercostal space between the mid and anterior axillary lines.

• This spot can be used when a standard-sized cannula is available.

"The traditional spot doesn't work 50% at the time with a standard-sized cannula...put it somewhere it does work."

Thoracostomy as an Alternative to Cannula

• In certain situations, a cannula may not be the best and safest option for chest decompression.

• Thoracostomy, which involves cutting a hole in the chest, can be a more effective method in cases where cannulas can easily be dislodged or prove ineffective.

• Choosing thoracostomy requires quick identification of the fifth intercostal space and making an incision just anterior to the midaxillary line.

"A cannula is not always the best and safest way to decompress a chest...thoracostomy is pretty much the same as the start of a formal chest drain."

Placement of a Formal Chest Drain

• Once chest decompression is performed using a cannula or thoracostomy, it is essential to follow up with the placement of a formal chest drain.

• The standard cannula may be too short 50% of the time, but it can be used in the cygnet costal space on the midclavicular line.

• In the pre-hospital setting, a four Acosta me method works best for placing a formal chest drain.

"The cannula or thoracostomy is only a temporary measure...go on to place a formal chest drain as soon as possible."

"Get a big cannula, use that in the cygnet coastal space, midclavicular line... if you don't have one, use the standard cannula and the chest drain spot."

Importance of Quick Intervention

• Chest decompression should be performed quickly in emergency situations.

• Delaying the procedure can lead to worsened hemodynamic compromise and potentially life-threatening consequences.

"You must go on to place a formal chest drain as soon as possible."