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Tension pneumothoraces not responding to needle thoracocentesis
  1. R Jones,
  2. J Hollingsworth
  1. Accident and Emergency Department, Aintree University Hospital Trust, Lower Lane, Liverpool L9 7AL, UK
  1. Correspondence to:
 Mr R Jones, 34 Heathfield Road, Liverpool, L15 9EZ, UK;
 robinski{at}doctors.org.uk

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A tension pneumothorax is a life threatening condition in which there is a large rise in intrathoracic pressure on the side of the affected hemithorax. This condition may rapidly lead to death.

Prompt treatment of the condition is required and most of the texts on the treatment of patients with this condition suggest that the pressure is released by the placement of a large bore trocar and cannula through the second intercostal space at the mid-clavicular line on the affected side.1 This procedure is intended to be diagnostic and temporarily therapeutic, relieving the pressure enough to “buy time” while preparations are made for placement of a chest drain.

We report three cases of tension pneumothorax that were not responsive to needle decompression. We believe that these cases illustrate a potential problem with needle decompression that may lead the less experienced practitioner to doubt their diagnosis with possible dire consequences for the patient.

CASE 1

An 18 year old man was admitted to the emergency department after crashing his car into a shop window. He had been trapped at scene by the displaced steering wheel, which was pressing against his chest. On arrival in the department he was complaining of severe left sided chest pain and difficulty in breathing. The patient was in severe respiratory distress and further examination revealed a resonant left hemithorax with absent breath sounds. A diagnosis of a left sided tension pneumothorax was made and a 14 gauge cannula …

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