Adult Medical Emergency Handbook - Scottish Intensive Care Society

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PNEUMOTHORAX
Tension pneumothorax is an EMERGENCY and requires immediate
treatment by inserting a 14G cannula in the 2nd intercostal space
in the mid-clavicular line on the affected side. A formal chest drain
can then be sited. Only individuals who are trained and competent
in chest drain insertion should perform it unsupervised.
SPONTANEOUS PNEUMOTHORAX
Respiratory Unit staff should be contacted from all A/E,
admission units for advice and further arrangements.
If the lungs are normal:
• Aspirate if complete collapse - aspirate in 2nd intercostal
space, mid-clavicular line with an 18G cannula, 50ml syringe and
3 way tap. This should follow explanation, skin cleansing and
infiltration of the site with adequate 2% lidocaine (lignocaine). If
the pneumothorax resolves or is rendered small the procedure has
been successful. Repeat once only.
• Moderate collapse (degree of collapse: small = a rim of air;