Adult Medical Emergency Handbook - Scottish Intensive Care Society

i
TENSION PNEUMOTHORAX
Signs
Diagnosis is NOT radiological but is clinical
• Cyanosis/low SpO /low PaO .
2 2
• Hypotension.
• Shock.
• Tracheal deviation away from side of other signs.
• Silent, resonant hemithorax.
Action
• 100% oxygen.
• 14G cannula inserted perpendicular to skin in 2nd intercostal
space, mid-clavicular line.
• Give analgesia.
• Formal intercostal drain insertion.
• CXR to check position and re-expansion.
INTERCOSTAL DRAINAGE TUBE INSERTION
Respiratory Unit staff can be contacted for insertion of
intercostal drain.
Respiratory Units, Western General Hospital and Royal Infirmary
of Edinburgh. Practical guidelines for intercostal drain insertion
and management. Final version 18/4/07
1. Preparation:
• Give oxygen as required and secure iv access.
• Atropine (600 micrograms) should be handy as profound vagal
stimulation, with resulting bradycardia, can occur during pleural
manipulation.
• Premedicate anxious patients with midazolam 1mg to 5mg iv or
diazepam 5mg to 10mg sublingually (ordinary tablets dissolve)
unless the patient is in respiratory failure. Flumazenil (300-600
micrograms) should be immediately available to reverse oversedation.
Morphine 2.5 to 10mg s/c is an effective alternative
premedication, the lower dose being appropriate in the frail and
elderly.
adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11
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