Tension pneumothorax Treatment

Tension pneumothorax
This is a medical emergency.

Essence:
Air drawn into the pleural space with each inspiration has no route of escape during expiration.
The mediastinum is pushed over into the contralateral hemithorax, kinking and compressing the great veins.
Unless the air is rapidly removed, cardiorespiratory arrest will occur.

Signs:
Respiratory distress, tachycardia, hypotension,
distended neck veins, trachea deviated away from side of pneumothorax.
Increased percussion note, reduced air entry/breath sounds on the affected side.

Treatment:
To remove the air, insert a large-bore (14-16G) needle with a syringe, partially filled with 0.9% saline, into the 2nd intercostal interspace in the midclavicular line on the side of the suspected pneumothorax.
Remove plunger to allow the trapped air to bubble through the syringe (with saline as a water seal) until a chest tube can be placed. Alternatively, insert a large-bore Venflon in the same location.
Do this before requesting a CXR.
Then insert a chest drain.