Another complication seen in patients with tracheostomies is a tension pneumothorax, which is usually caused primarily by positive pressure mechanical ventilation or over-aggressive bag-mask-ventilation.
With a tension pneumothorax, air escapes from the injured lung and pressure begins to build up within the chest. Increased air pressure collapses the lung and pushes on the heart. If compressed, the heart is not able to function properly. This may create a decrease in preload and venous return to the heart. Most commonly caused by penetrating chest injury however blunt injuries may cause a tension pneumothorax as well. This condition may be quickly fatal if immediate intervention is not performed.
The immediate treatment to relieve a tension pneumothorax in the prehospital setting is to perform a chest decompression. This skill is performed by appropriately trained paramedics; refer to your local protocol. EMS personnel will locate the affected side; usually by a decrease / absent breath sounds, and insert a catheter into the pleural space. The needle and catheter are placed between the second and third intercostal space, midclavicular line. (18)
