Algorithm
- Clinical diagnosis: severe dyspnea, absent breath sounds, tracheal deviation, hypotension.
- Immediate needle decompression — do not delay for imaging.
- 2nd intercostal space, midclavicular line OR 4th–5th ICS anterior axillary (ATLS).
- Follow with definitive chest drain (ICD).
- High-flow oxygen; treat underlying cause (trauma, ventilation).
Red flags
- • Traumatic arrest / obstructive shock — decompress without delaying
- • Bilateral findings — reassess tube/needle position
- • Re-accumulation after decompression — definitive chest drain
Medications by step
Step 1 — Decompression
- Needle thoracostomy · —
14–16 G cannula, 2nd ICS MCL
Step 2 — Analgesia
- Morphine · i.v.
2.5–5 mg IV PRN
References
- • ATLS — Thoracic trauma (2023)
Updated: Июль 2026