Pediatrics

Tension Pneumothorax

Diagnosis

May see:

  • Unilateral breath sounds
  • ↑ HR
  • ↓ SpO2
  • ↓ BP
  • Tracheal deviation
  • Mediastinal shift

Diagnosis

May see:

  • Unilateral breath sounds
  • ↑ HR
  • ↓ SpO2
  • ↓ BP
  • Tracheal deviation
  • Mediastinal shift

  1. Perform immediate needle decompression, then chest tube placement

  2. Needle decompression, 2nd rib space superior to 3rd rib, mid-clavicular line

    • 14-16g angiocath for teens/adults
    • 18-20g angiocath for infants/children

  3. Stop N2O; increase O2 to 100%

  4. Secure airway with endotracheal tube

  5. Reduce positive ventilation pressure

  6. Consider CXR, Lung Ultrasound, transillumination to confirm diagnosis

  7. Administer vasopressors for circulatory collapse

  8. Chest tube insertion, 5-6th intercostal space, mid-axillary line

  9. If no improvement in hemodynamics after a rush of air, consider:

    • Needle decompression of contralateral side
    • Presence of pneumopericardium
    • Scan both lungs with ultrasound or transillumination to evaluate for alternate side or insufficiently decompressed pneumothorax

  10. Consider DDx

  11. Crisis Management (If Severe)

    Notify surgeon, call for help and code cart

  12. Call for Transesophageal Echocardiography

  13. Start chest compressions

  14. Give epinephrine 10 MICROgrams/kg IV/IO

  15. If cardiac arrest, go to CARDIAC ARREST

  16. Consider ECMO

Patient weight

Between 0.5 kg and 120 kg

Reset the checklist?

Checked steps, the timer and this crisis log are cleared. The patient’s weight is kept.

Finish the crisis?

The timer pauses, and you can review the case and the event log.