how to perform needle thoracostomy Navigation

Complications of needle thoracostomy: A comprehensive clinical review. Objective 1: Com 1. Gauze squares, 4 x 4 in (10) Sterile adhesive tape, 4 in wide. B. Describe Light’s Criteria for pleural effusion and list 5 other tests to perform on pleural fluid. Perform imaging urgently. Aspirate as for pneumothorax (above) expelling fluid to the outside as necessary. How to Perform the Procedure. Define . If that is the case, a bougie can help! Management of tension pneumothorax typically involves reducing the pressure in the pleural space by emergent chest decompression with needle thoracostomy. Multiple studies have shown the safety and efficacy of the Please note that all guidance is currently under review and some may be out of date. If done in the emergency department, the patient is then admitted to the hospital. It therefore represents the pre-ferred first line technique for many emergency providers and is recommended in several trauma guidelines [2, 3]. _____ Did not secure the catheter hub to the chest wall. Insert the 14 or 16 gauge angiocatheter with needle placed just above the rib, perpendicular to the skin. a. Tube thoracostomy requires a 36- to 40-F tube for hemothorax in adults or 20- to 24-F tube in children. It is recommended to discuss specific expectations for management with the patient’s attending physician. as it relates to thoracic decompression. On a shift last week, we had a patient present with a spontaneous pneumothorax. Vaseline gauze. On a shift last week, we had a patient present with a spontaneous pneumothorax. In needle aspiration, air is manually withdrawn using an intravenous catheter connected to a syringe and three-way stopcock. Michael Firstenberg. Page 5 of 13 Procedure for thoracostomy The patients arm is abducted and the 5th intercostal space identified just anterior to the mid-axillary line (see Figure 1). Needle thoracostomy may be a lifesaving procedure in the management of tension physiology. A growing body of evidence suggests the use of longer angiocatheters may result in more effective NT as compared to the currently recommended 5cm catheter by ATLS ( … … Tube thoracostomy involves the following steps: You will sit in a comfortable position or lie on the operating bed with one arm over your head. success rates in needle thoracostomy. The chest wall thickness in the 2nd intercostal space, mid-clavicular line, was determined by ultrasound in 54 patients aged 18 to 55 years, and ranged from 1.3 to 5.2 cm (mean 3.2 cm). Chest decompression should be performed with finger thoracostomy followed by chest drain inserMon; needle decompression is not adequate. Classical teaching is to perform this in the 2nd ICS midclavicular line but is this the easiest and most effective place to perform it? If patient is awake/alert, anesthetize the skin, muscle and down to pleura. Don sterile gloves. Using a No. 10/11 scalpel, make a 4cm through skin over and parallel to the superior border of the inferior rib. Using Kelly clamps, quickly blunt dissect through subcutaneous tissue and muscle just over the superior border of the inferior rib. Providers who place thoracostomy tubes (diameter ≥16 French [Fr]) or thoracostomy catheters (≤14 Fr) should be privileged to perform the procedure and treat/address the potential complications and should be well versed with all the options available as well as the equipment required for their placement and maintenance. There is a significant amount of recent, relevant research regarding needle thoracostomy for chest decompression. A more superior insertion site is preferred to avoid penetration into the abdominal cavity. After locating the landmark, sterilize the space using an antiseptic, like chlorhexadine. Next, place the long large bore cannula onto a sterile field and put on sterile gloves. You are now ready to perform the needle decompression. We recommend that you also refer to more contemporaneous evidence in the interim. 16 Traditionally the recommended needle thoracostomy site has been the second intercostal space, midclavicular line (2ICS-MCL). The risk of not performing needle thoracostomy in a child spiralling towards death from a tension pneumothorax is far greater than the risk of performing the procedure in a child without a … Place the patient in the supine position. After reviewing the error, they were then able to go on to successful placement of the catheter. These … Needle thoracostomy is a temporising procedure. Watch this video to see the second technique using a three-way stopcock and a … Use CT for stable paMents and Chest x-ray/eFAST for those with severe respiratory distress and/or haemodynamic compromise. They have a one-way value which is … How do you properly secure a chest tube? It ... April 2014). This is performed by physicians, and paramedics, usually via needle thoracostomy or with a thoracostomy tube (chest tube). Follow-up chest radiography should be performed approximately 4 hours after the procedure, and catheter can be removed at that time if … After doing a needle thoracostomy, insert a chest tube as soon as possible. Define . The needle length and the anatomical location for the needle placement should be decided wisely. To put it simply, the procedure involves inserting a large bore needle or cannula through the chest wall into the pleural cavity -- to allow the air from within to escape. Indications . They can be visualized on ultrasound. Needle Thoracostomy – PS09 Performance Validation Form Performance Objective: Relieve intrathoracic pressure resulting from tension pneumothorax to improve cardiac output and allow the return of spontaneous respirations or effective PPV. Procedure: A. At the completion of clinical training consider offering both a written and skills competency evaluation. There are easy to see when through a chest or abdominal wall. At the end of the day, if you have a patient crashing in front of you from a tension hemopneumothorax, a finger thoracostomy is the only way to know for sure you got into the thorax and relieved the tension physiology. 5. The literature has reported many incidences where needle decompression … Describe the seldinger technique for chest tube insertion 4. Doctors suggest when performing a needle thoracostomy the patient’s BMI, chest wall thickness should also be considered. Although the patient was hemodynamically stable, he was very uncomfortable and really short of breath. METHODS: A convenience sample of 111 computed tomography (CT) scans of the chest in trauma and medical resuscitation patients at a … Medical Information Search. thoracostomy. 5 Re-expansion of the lung parenchyma and resolution of the hemothorax should be monitored with serial CXRs. Using the 25-gauge needle, inject 5 mL of local anesthetic solution into the skin that will overlie the initial incision. Background: The Combat Lifesaver course taught to nonmedical personnel includes instruction on performing needle thoracostomy to decompress tension pneumothorax, the second leading cause of preventable combat death. Needle driver. B. Needle thoracostomy requires a 12- to 16-gauge angiocatheter, 3 to 4.5 inches in length, and a 5–10 mL syringe. Redirect the needle along the expected course of the chest tube. Pneumothorax drainage topic includes clinical features of pneumothorax, preparation for procedure, emergency needle aspiration and procedure for insertion of an intercostal catheter. Thus, the location of excess air in the pleural cavity can be accurately identified. A 14 … Under current national guidelines, paramedics are not permitted to perform thoracostomy but may perform needle chest decompression (NCD) of the thoracic cavity when treating a suspected tension pneumothorax.3 This permits treatment of a tension pneumothorax but can be complicated by not traversing the chest wall,4 becoming blocked with tissue and does not allow appreciation of … Consider performing bilateral needle thoracostomy on trauma patients in cardiac arrest, or in imminent pre-arrest states on a patient with chest injury where tension pneumothorax may be present. There is no minimum weight requirement for performing a needle thoracotomy when a needle thoracotomy is indicted. This was performed in the fifth intercostal space, mid-axillary line, 30 minutes after arrival in the resuscitation room. Consider performing bilateral needle thoracostomy on trauma patients in cardiac arrest, or in imminent pre-arrest states on a patient with chest injury where tension pneumothorax may be present. Instrument/Finger Thoracostomy . Are we able to perform decompression on patients 50kg or less looks like the 18g was taken out? Perform needle thoracostomy X X X X X X Monitor thoracostomy tubes X No X X X No Monitor & adjust IV solutions containing potassium 20Eq/L X X X X X No . Vaseline gauze. Results: All students were eventually able to use the model to perform the procedures without prompting or guidance. Under current national guidelines, paramedics are not permitted to perform thoracostomy but may perform needle chest decompression (NCD) of the thoracic cavity when treating a suspected tension pneumothorax.3 This permits treatment of a tension pneumothorax but can be complicated by not traversing the chest wall,4 becoming blocked with tissue and does not allow appreciation of … The standard teaching does recognize that needle decompression is only a temporizing measure until tube thoracostomy can be performed. But why not try this method, which takes a few seconds longer to set up, but gives you better feedback and allows you to temporarily close the system in For traumatic tube thoracostomy indications, the appropriate size is 36-40F. This size will be necessary to accommodate the drainage of blood. To begin the procedure, place the patient in a supine position or at a 45-degree angle, to reduce the risk of diaphragm elevation and improper chest tube placement. The needle should be inserted at … To give us more time to prepare for the chest tube, it was decided to perform a needle thoracostomy. To determine the length of catheter required to perform a needle thoracostomy, as determined by chest wall thickness, to treat the majority of patients presenting to the emergency department (ED) with a potential tension pneumothorax. of the following: a. Methods: A convenience sample of 111 computed tomography (CT) scans of the chest in trauma and medical resuscitation patients at a … potential complications . Patient should be in supine position (lying on the back). Take a look at the videos below showing Dr. Hinckley walking … V. Procedure. 2. The finger thoracostomy is an alternative to needle thoracostomy for emergent decompression of a suspected tension pneumothorax 2. Thoracostomy tubes are commercially available as single tubes and complete thoracostomy kits. C. If tension pneumothorax is present and needle thoracostomy is indicated, proceed to the procedure as rapidly as possible. When air, blood, or other fluids accumulate in the . of improperly performed thoracic decompression procedures (needle decompression or thoracostomy) Discuss current . This procedure may be done either alone or in conjunction with needle decompression of the chest. Insert the thoracostomy needle, piercing the skin over the rib below the target interspace, then directing the needle cephalad over the rib until the pleura is punctured (usually indicated by a pop and/or sudden decrease in resistance). After doing a needle thoracostomy, insert a chest tube as soon as possible. It’s done to drain fluid, blood, or air from the area around your lungs. What does a low pH indicate? For chest thoracostomy, it may be challenging to locate the tract because of generous adipose tissue. Needle Thoracostomy, Air aspiration, Epidural space, Reciprocating Procedure Device, Actuating mechanism. Unlike needle decompression, finger thoracostomy allows maximum release of air/liquid from the pleural cavity and full lung re-expansion, making it the only effective option in some patients. Administer supplemental oxygen with a nasal cannula or by an oxygen mask. Advanced Trauma Life Support guidelines recommend the use of a cannula 3 to 6 cm long to perform needle thoracocentesis for life-threatening tension pneumothorax. We need to perform perform needle decompression of the chest quick-smart… Here’s how Michael McGonigal from The Trauma Professional’s blog does it: Needle decompression (McGonigal) But, hang on a sec, perhaps we shouldn’t be using that needle after all… Listen to Scott Weingart’s take on this in Needle versus Knife II: Needle vs. Finger Thoracostomy. Immediately after needle thoracostomy, insert a chest tube to provide ongoing drainage in a closed system ( Chapter 23.8 ). Perform time out with all appropriate steps. Therefore, it is difficult to make a “one size fits all” set of instructions about the specific management recommendations for all chest tubes. This is performed by physicians, and paramedics, usually via needle thoracostomy or with a thoracostomy tube (chest tube). An 18g catheter was determined not to be rigid enough or a large enough diameter to be effective. Other tubes can be modified to perform as thoracostomy tubes; however, several criteria must be fulfilled. The proce- dure requires a 16-gauge or 18-gauge over-the-needle catheter, tubing with a three-way stopcock, and a 50-ml or 60-ml syringe. OBJECTIVES: To determine the length of catheter required to perform a needle thoracostomy, as determined by chest wall thickness, to treat the majority of patients presenting to the emergency department (ED) with a potential tension pneumothorax. It’s done to drain fluid, blood, or air from the area around your lungs. Insert the needle just above the 5th or 6th rib. Finger thoracotomy is a more effective equivalent of needle decompression (also known as needle thoracotomy or needle thoracostomy). List 2 contraindications and 5 complications Wisecracks 1. To give us more time to prepare for the chest tube, it was decided to perform a needle thoracostomy. Time should not be wasted on full asepsis (that is, fully preparing the skin and surgically draping the … International Journal of Critical Illness and Injury Science, 2015. Needle thoracostomy is gener-ally easier to learn, faster to perform and less invasive than surgical decompression. March 2013 Procedures Imperial Kern Los Angeles Marin Merced Monterey Orange Riverside Sacramento San Benito San Diego Perform defib & cardioversion X X X X X X X Visualize airway by use of laryngoscope & remove foreign bodies X X … For example, X-rays, computed tomography (CT) and even ultrasound of this cavity can be used. _____ Did not recognize progressive respiratory distress as an indication for needle decompression. In particular, Scott Weingart from EMCrit has a great quick n’ dirty cric video which can be found here. Equipment: Appropriate PPE, thoracostomy manikin or simulated chest, Minimum 14ga x 3.25” catheter designed for needle decompression, stethoscope, stopcock or one way valve, tape, antiseptic agent, tape. In particular, Scott Weingart from EMCrit has a great quick n’ dirty cric video which can be found here. Needle thoracostomy is a temporising procedure. Needle Thoracostomy. Objectives: To determine the length of catheter required to perform a needle thoracostomy, as determined by chest wall thickness, to treat the majority of patients presenting to the emergency department (ED) with a potential tension pneumothorax. Needle thoracostomy, also known as "needle decompression" is a procedure performed to stabilize deteriorating patients in the life-threatening situation of a tension pneumothorax. Needle Thoracostomy: Implications of Computed Tomography Chest Wall Thickness Needle Thoracostomy: Implications of Computed Tomography Chest Wall Thickness Givens, Melissa L.; Ayotte, Karen; Manifold, Craig 2004-02-01 00:00:00 Objectives: To determine the length of catheter required to perform a needle thoracostomy, as determined by chest wall thickness, to treat … The tube is often hooked up to a suction machine to help with drainage. Barton E.D. If you perform the finger thoracostomy, you need to know what you are doing. Describe the procedure of thoracentesis. Needle decompression is appropriate for clinically stable patients with large primary spontaneous pneumothoraces. Attach a large-bore (16- to 19-gauge) thoracentesis needle-catheter device to a 3-way stopcock, place a 30- to 50-mL syringe on one port of the stopcock and attach drainage tubing to the other port. The area should be … Dr. Weingart points out that, in trauma, compression (chest compressions) won’t help, while decompression (decompression of a tension pneumothorax) will help much more often. V. Procedure. Complications of needle thoracostomy: A comprehensive clinical review. _____ Did not know that the needle to be used was a 14 gauge, 3.25 inch needle. At the completion of clinical training consider offering both a written and skills competency evaluation. needle thoracostomy (NT) in the mid-clavicular line between the second and third ribs to decompress suspected pneumothoraces. 2548 AMR : Matthew Scott . chest wall . Stanislaw Stawicki. After a fine-needle aspiration or core-needle biopsy, the site may be tender for two to three days and you may have a bruise around the site. A piece of tape along the rim of the bottle is used to hold the tubing in a position that keeps the hub under the surface of the water. 13. This video taken via thoracoscope demonstrates a tension pneumothorax and needle thoracostomy. The aim should be to perform a simple thoracostomy first, with tube thoracostomy as a secondary priority. Gauze squares, 4 x 4 in (10) Sterile adhesive tape, 4 in wide. The hub of the tubing is immersed in a 4 ounce baby bottle of sterile water. A cadaver study found that the fifth… To perform tube thoracostomy, a large-bore tube (32F to 40F) should be placed in the 4 th or 5 th intercostal space at the anterior axillary line, and connected to water seal and suction (20-30 mL H20). the simple thoracostomy, also known as finger thoracostomy, can quickly be performed by prehospital providers to reverse trauma arrest secondary to tension pneumothorax. TCCC and most EMS protocols list needle thoracostomy as the intervention of choice in the management of a suspected tension pneumothorax. I did one on a pulseless guy with a pulverized side, but only blood came out. 1. The simple thoracostomy allows maximum release of air and blood from the pleural cavity, thus allowing full re-expansion of the lung. needle decompression, finger thoracostomy or tube thoracostomy. Performance Criteria: 100% accuracy required on all items marked with an * Before performing needle thoracostomy, paramedics must: pleural cavity it may be drained by thoracostomy. METHODS. 3. SAEMS PREHOSPITAL PROTOCOLS Effective: 12/1993 Revised: 9/99, 1/06, 06/10, 1/17/2017 C. If tension pneumothorax is present and needle thoracostomy is indicated, proceed to the procedure as … a simple thoracostomy. Turkel needles can be used for many indications, including to perform a needle thoracostomy, thoracentesis, and paracentesis. A retrospective review of patients undergoing needle decompression by prehospital providers concluded the procedure is safe to perform and, when done in the decompensating trauma patient, can have beneficial outcomes. Other physicians can relieve a tension pneumothorax with needle thoracostomy. Thoracostomy is a procedure that places a tube in the space between your lungs and chest wall (pleural space). Needle decompression Thoracostomy (repeat finger sweep if clinical deterioration) If a Level 6 Practitioner Level 5 Practitioner Level 6 + Practitioner . 2. UC Emergency Medicine PRO. Physicians perform a thoracostomy to treat conditions including: pneumothorax (collapsed lung), a collection of air in the pleural space that causes the lung to collapse. Prep the skin over the 4th or 5th intercostal space in the mid-axillary line (MAL) with ChloraPrep. B. The needle will need to be about 5-8 cm long, depending on the amount of muscle and fat tissue covering the rib cage. 5 The surgeon will perform a chest ultrasound to find and mark a safe site in your chest to insert the chest tube. for drainage. While there are many great videos out there showing how to perform a cric, they are usually performed on cadavers/simulators, which most of us do not have routine access to. scientific evidence . The thoracostomy tube is usually placed between the ribs in the sixth or seventh intercostal space at the mid-axillary line. Wikipedia. Chest tube thoracostomy involves placing a hollow plastic tube between the ribs and into the chest to drain fluid or air from around the lungs. 4. Chest tube placement is an inpatient procedure. Inject … I believe that this information would impact my practice and that I would think more to perform a needle thoracostomy in the anterior axillary line in the 5th intercostal space, especially in patients with high BMIs where mid-clavicular line thoracostomy would be difficult. a simple thoracostomy. It is important to have the proper equipment on hand to successfully perform a needle decompression. While the utility of needle decompression vs. simple finger thoracostomy followed by chest tube insertion can be debated, in the pre-hospital setting, needle decompression remains within the realm of paramedics and may at times be most practical. Some students had minor technical errors in catheter placement or advancement, which were corrected. proficiently perform the procedure. Using the 23-gauge or, preferably, 27-gauge needle, infiltrate approximately 5 mL of the anesthetic solution to a wide region of subcutaneous tissue that is superior to the targeted site of initial incision. Patients with . C. If tension pneumothorax is present and needle thoracostomy is indicated, proceed to the procedure as rapidly as possible. How to perform a needle decompression for a tension pneumothorax A needle decompression should only be performed if the patient has a tension pneumothorax. Different types of catheters can be used to perform needle aspiration, and you should be familiar with the specific devices available at your institution. A "pop" may be felt as the needle transversed the pleura. Some EPs will attached a 10cc syringe partially filled with saline or water to the end of their angiocath/needle set. A tube thoracostomy (open chest drainage) is a surgical procedure to drain the collection of pleural fluid, air, blood, or pus from your pleural cavity through a tube inserted in your chest. Thomas Papadimos. How is needle thoracostomy performed? demonstration, students were asked to perform thoracentesis and thoracostomy. Fortlage D. Rosen P. Prehospital needle aspiration and tube thoracostomy in trauma victims: a … ICS2-MCL: 38% (95% CI 24 – 54%) ICS4/5-MAL: 31% (95% CI 10 – 64%) ICS4/5-AAL: 13% (95% CI 8 – 22%) Strengths: Adhered to the Preferred Reporting Items for Systematic Reviews and meta-analyses (PRISMA) Adhered to the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) Limitations: Excluded ultrasound … As you traverse the pleura, you may hear the distinctive rush of air from the decompressed tension pneumothorax. 3. INTRODUCTION . Page 1. Not only that, but it was a tension pneumothorax. Immediately after needle thoracostomy, insert a chest tube to provide ongoing drainage in a closed system (Chapter 23.8). A thoracostomy is a small incision of the . 12/04/2015 . Needle Thoracostomy Failure Rate with 5cm Angiocatheter. These needles have 5 main advantages over others: Combination of blunt and sharp needle when entering into a cavity. Also, unless you’re rapidly prepared to perform a chest tube with sterility in mind, needle decompression may be a better option. Needle decompression of a pneumothorax is a time critical and life saving procedure. Insert the thoracostomy needle, piercing the skin over the rib below the target interspace, then directing the needle cephalad over the rib until the pleura is punctured (usually indicated by a pop and/or sudden decrease in resistance). The video "Tension Pneumothorax and Needle Thoracostomy" claims to show the needle decompression of a large tension pneumothorax from the “inside” of the patient’s chest cavity by … This means that trauma professionals should don appropriate personal protective equipment as dictated by their local policies and procedures before performing these procedures. A. 11 Pages. The patient’s condition did not warrant immediate needle thoracocentesis and so a decision was made to proceed straight to tube thoracostomy. of improperly performed thoracic decompression procedures (needle decompression or thoracostomy ) Discuss current . In the backcountry, there are concerns about the known complications of retension from a kinked tube, hematoma, infection, subcutaneous placement. Until we have more data, needle and tube thoracostomy procedures should be considered at least a droplet-prone procedure, if not an aerosol-producing one. _____ Did not perform the needle decompression at the proper landmarks or on the same side as the chest injury. The tube remains in the chest until all or most of the air or … Needle driver. Brian Hoey. Epperson M. Hoyt D.B. Needle Thoracostomy. Thoracostomy is a procedure that places a tube in the space between your lungs and chest wall (pleural space). steps needed to perform and confirm . steps needed to perform and confirm . This video shows the anatomic landmarks and the process of performing a needle thoracostomy. While there are many great videos out there showing how to perform a cric, they are usually performed on cadavers/simulators, which most of us do not have routine access to. Not only that, but it was a tension pneumothorax. … 3. Allow to dry. Insert the needle along the upper border of the rib while aspirating and advance it into the effusion. The latest data suggest that the optimal needle for use in treatment of a tension pneumothorax in adult patients is a 3.25 inch 14 gauge (or larger diameter) needle. In thirty-one patients (57 percent) the chest-wall thickness (CWT) was greater than 3 cm, the minimum recommended cannula … Three studies examine the question of the optimal site to use for thoracostomy. In this podcast I speak with Zaf Qasim, an EM physician in the US about the topic and the underpinning EBM. When performing a needle thoracostomy on a preterm or term neonate some operators prefer to use a butterfly type of needle with the manufacturer’s tubing left attached. 7 years ago. Objective 1: Co What is Catamenial pneumothorax? Procedure. decompression are either needle thoracostomy or open finger thoracostomy [1, 2]. Care and management of the thoracostomy tubes (chest tubes) are subject to the direction and practice pattern of the responsible physician. Many experts would proceed directly to definitive treatment and bypass the step of needle decompression if the capability to perform tube thoracostomy is immediately available. Spontaneous pneumothorax occurs in the absence of disease or injury. Complicated pneumothorax may occur during heart or lung surgery or as a result of a traumatic injury (such as a gunshot or stab wound) to the chest. Policy: Paramedics may perform needle thoracostomy on patients with a suspected tension pneumothorax in accordance with this policy. The tube must be sterile, elicit minimal tissue reaction in situ, have multiple fenestrations at the distal end, and be able to withstand the generation of negative pressure during … IV. Clinical suspicion of pneumothorax (e.g., trauma, dyspnea, chest pain), b. Systolic Blood Pressure less than 90 mmHg (adults) or 70 mmHg (pediatrics less than 40 kg) and … as it relates to thoracic decompression. There has been much digital ink spilled over the topic of needle thoracostomy (check below for some additional reading) with most of the hub bub surrounding the proper location to place the needle. ALL. Timing of chest drain inserMon (following finger thoracostomy) will depend on clinical situaMon. Consider performing bilateral needle thoracostomy on trauma patients in cardiac arrest, or in imminent pre-arrest states on a patient with chest injury where tension pneumothorax may be present. Demonstration of simple thoracostomy, finger thoracostomy and tube thoracostomy. How is it treated? Instrument/Finger Thoracostomy is a procedure in which an incision is made into the chest wall and pleural cavity to drain air or fluid. Chest tube of appropriate size: Man - 28-32F; woman - 28F; child - 12-28F; infant - … potential complications . scientific evidence . If possible, experts will perform tests to obtain internal images of the chest area. Although the patient was hemodynamically stable, he was very uncomfortable and really short of breath. A tube thoracostomy may be performed due to such conditions as pleural effusion, pneumothorax, hemothorax, hemopneumothorax, hydrothorax, chylothorax, and empyema. For a simple pneumothorax, an 18- to 28-F tube in adults or 14- to 16-F tube in children is sufficient. What to Think About: Lymphoma, or cancer that begins in the lymph nodes, is the most common form of cancer in teens and younger adults. A. 31. BOUGIE-ASSISTED THORACOSTOMY Clearly, her girth limits the success rate of needle thoracostomy. However, currently taught practices may be ineffective in the successful treatment of a tension pneumothorax.