• Traumatic cardiac arrest with torso involvement
Critical Care, Clinical Support & Special Operations Paramedics only
  • Suspected tension pneumothorax with respiratory and/or haemodynamic compromise
    Ambulance Paramedics only
    • Patients not in cardiac arrest unless trained and authorised
    • Consider ASMA consult in a patient with suspected tension pneumothorax and respiratory and/or haemodynamic compromise.
    Patient Factors & Considerations
    • Perform bilaterally in traumatic cardiac arrest
    • A patient not in cardiac arrest can receive unilateral treatment on the affected side, with ASMA authorisation where applicable
    • The site selected should be superior to the third rib to avoid trauma to intercostal blood vessels and nerves.
    • Procedure can be repeated if tension pneumothorax redevelops.
    • It is very difficult to detect breath sounds/chest rise and fall in Traumatic Cardiac Arrest, so tension pneumothorax should be assumed whenever there is trauma to the torso
    • Use the angio cath 14g needle, as shorter cannulas are unlikely to penetrate into the plural space
    • All relevant infection control methods to be utilised.
    • Prepare equipment required:
      • Alcohol/betadine swab
      • Angio Cath 14g cannula**
      • 10mL syringe & NaCl
      • Stethoscope

      ** Use an alternative size needle if the Angio-Cath is obviously too long for the anatomical features of the patient (e.g. younger / frail etc.)

    • Locate the specific landmark on the affected side: 2nd intercostal space, mid-clavicular line.
    • Clean the landmark site with an alcohol/betadine swab.
    • Connect the angio cath 14g cannula to the 10mL syringe.
    • Insert the needle at a 90° angle to the patient’s chest wall.
    • While inserting the needle, aspirate the 10mL syringe. Resistance is felt until the cannula enters the pleural space and releases air and/or fluids.
    • Repeat procedure for opposing pleura.
    • Remove the needle leaving the cannula in place.
    • Re-evaluate the patient.
    • Auscultate the chest.
    • If found that the pneumothorax re-tensions:
      • Repeat the procedure leaving the initial cannula in situ.
      • Insert second cannula immediately adjacent to the first.



    • In noisy high-stress environments, release of air may be difficult to detect. Signs of success include an improving SpO2, easing respiratory effort and decreased airway pressures in ventilated patients.
    • Document pertinent points as necessary
    Additional Information
    • Improper diagnosis and insertion of a pleural catheter may lead to the creation of a pneumothorax or tension pneumothorax
    • Incorrect placement may result in life threatening injuries to the heart, lung or surrounding vessels.


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