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- Pneumothorax:
    - even a small pneumothorax will generally require a chest tube if any type of surgery is required since the size of the pneumothorax may
            increase due to the positive pressure ventilation;

- Tension Pneumothorax:
    - condition in which air is under pressure in the pleural space;                                
    - can occur when a parenchymal or bronchial injury allows free air to move into an intact pleural space;                              
    - commonly seen in blunt trauma such as head on MVA, falls, and lateral impacts;
    - danger is that the patient will expire due to circulatory embarrasment, as pressure develops in one chest cavity, the heart is displaced toward the opposite
             side which impairs venous return of the SVC and IVC;
    - diagnosis:
             - dx should be made clinically rather than radiographically;
             - listen for decreased breath sounds, and hyperresonance;
             - tracheal deviation is often difficult to feel unless it is pronounced;
             - dx by CXR implies that treatment was needlessly delayed;
    - treatment:
             - needle rx for tension pneumothorax
             - identify the 2nd ICS in the MCL on the hyperresonant side;                
             - mark the point with a pen;                                                
             - insert 14 gauge IV needle, listen for rushing air w/o suction;                  
             - insert the chest tube, (placement of a needle alwasys mandates a chest tube);                                                

Chest Tube Removal: End-Inspiration or End-Expiration? Bell RL, et al. J Trauma. 2001;50(4):674-677

Needle thoracostomy in the treatment of a tension pneumothorax in trauma patients: what size needle?

Emergency War Surgery - thoracic injuries

Indications for thoracic needle decompression.

Images in Clinical Medicine. Flail Chest

Proper catheter selection for needle thoracostomy: A height and weight-based criteria.