| Source |
Recommendations |
| International Trauma Life Support (ITLS) [21] |
Indication: the presence of tension pneumothorax with decompensation as evidenced by any of the following: respiratory distress and cyanosis, signs of shock, and decreasing level of consciousness |
| The standard treatment for tension pneumothorax is needle decompression. However, ITLS urges providers to consider performing a simple thoracostomy, also known as a finger thoracostomy, instead of needle decompression due to their high failure rates, short catheters, kinking, and improper location |
| Location: fifth intercostal space midaxillary line |
| EMS System for Metropolitan Oklahoma City and Tulsa 2023 Medical Control Board Treatment Protocols [22] |
Indication: suspected tension pneumothorax |
| Clinical signs: suspected pneumothorax AND systolic blood pressure of less than 100 mm Hg (<70 + (2 × age in years) mm Hg in pediatric patients) AND three or more of the following: air hunger, cyanosis, decreased breath sounds, jugular venous distension, and tracheal deviation |
| Location: second intercostal space midclavicular line |
| Contraindications: no absolute contraindications |
| Complications: tension pneumothorax, lung laceration, hemothorax, and infection |
| Avoid needle thoracostomy medial to the midclavicular line. Inferior to a rib and inferior to the right sixth intercostal space to avoid the upper margin of the liver |
| Maryland Institute for Emergency Medical Services Systems [23] |
The site for needle thoracostomy in pediatric patients under 15 years of age is the second intercostal space midclavicular line |
| Patients 15 years and older: fifth intercostal space at the anterior axillary line (preferred) or second intercostal space at the midclavicular line |
| Indications: life-threatening tension pneumothorax in the extremis with absent lung sounds AND a clear evidence of hemodynamic compromise to include hypotension (systolic blood pressure < 100 mm Hg) and/or arrest |
