REBEL Core Cast 139.0: Pneumothorax Decompression

6 snips

Aug 18, 2025

Dive into the world of pneumothorax decompression with insights on recognizing tension pneumothorax, especially in critical scenarios. Learn why traditional needle decompression might not cut it and why finger thoracostomy takes the crown for effectiveness and reliability. Discover how ultrasound can quickly confirm diagnoses and the importance of swift action in emergency medicine. This discussion highlights the need to think beyond classic techniques and emphasizes better practices for patient care.

Ask episode

AI Snips

Chapters

Transcript

Episode notes

INSIGHT

Broaden Your Tension Pneumo Triggers

Tension pneumothorax can present without classic signs like tracheal deviation or absent breath sounds.
Suspect it in trauma, post–central line placement, and any decompensating mechanically ventilated patient.

ADVICE

Confirm With Point-Of-Care Ultrasound

Use point-of-care ultrasound (POCUS) to confirm suspected pneumothorax when time allows.
Look for absent lung sliding or the lung point sign to rapidly confirm the diagnosis.

INSIGHT

Problems With Classic Needle Site

Traditional needle decompression in the 2nd ICS MCL has significant limitations and risks.
Misidentification of the space and nearby critical structures make that location suboptimal.

Get the Snipd Podcast app to discover more snips from this episode

Get the app

📌 Key Points

🧠 Think Beyond Trauma: Don’t forget to suspect tension pneumothorax in ventilated patients who suddenly crash or after a central line placement! 🫁⚠️
🔍 Confirm with Ultrasound: If the patient is stable enough, grab the probe! 🖐️📟Ultrasound can rapidly confirm tension PTX and avoid unnecessary delays.
💉🚫 Needles Are Out: Needle decompression? Meh. Finger thoracostomy is faster, more reliable, and more definitive. 🖐️🫁

Click here for Direct Download of the Podcast.

📝 Introduction

On this episode of the Rebel Core Cast, Swami takes a deep dive into pneumothorax decompression, focusing on the need for improvements beyond the classic teachings. Covering scenarios where immediate decompression is critical, particularly in tension pneumothorax, Swami discusses the limitations of needle decompression, especially in the second intercostal space at the midclavicular line. He highlights the importance of using POCUS for diagnosis and recommends skipping needle decompression in favor of finger thoracostomy for a more reliable and effective treatment. Key takeaways emphasize recognizing tension pneumothorax in various clinical situations and the advantages of finger thoracostomy over traditional techniques.

⏰ Highlights

00:00 Introduction to Pneumothorax Decompression
00:17 Recognizing Tension Pneumothorax
01:00 Common Scenarios for Pneumothorax
01:34 Confirming Diagnosis with POCUS
01:50 Issues with Needle Decompression
03:21 Advantages of Finger Thoracostomy
04:11 Key Takeaways and Conclusion

📚 References

Ferrie EP et al. The right place in the right space? Awareness of site for needle thoracentesis. Emerg Med J 2005; 22: 788-9 PMID: 16244336
Laan DV et al. Chest wall thickness and decompression failure: a systematic review and meta-analysis comparing anatomic locations in needle thoracostomy. Injury; 2016; 47(4): 797-804 PMID: 26724173
Terboven T et al. Chest wall thickness and depth to vital structures in paediatric patients – implications for prehospital needle decompression of tension pneumothorax. Scan J Trauma Resusc Emerg Med 2109; 27(1). PMID: 30992028

Post Peer Reviewed By: Marco Propersi, DO (Twitter/X: @Marco_propersi), and Mark Ramzy, DO (X: @MRamzyDO)

👤 Associate Editor

Anand Swaminathan

MD, MPH

All Things REBEL EM

Meet The Team

REBEL Core Cast 139.0: Pneumothorax Decompression

Broaden Your Tension Pneumo Triggers

Confirm With Point-Of-Care Ultrasound

Problems With Classic Needle Site

🧭 REBEL Rundown

📌 Key Points

📝 Introduction

⏰ Highlights

📚 References

👤 Associate Editor

Anand Swaminathan

MD, MPH

🔎 Your Deep-Dive Starts Here

REBEL Core Cast 139.0: Pneumothorax Decompression

REBEL Core Cast 137.0: A Simple Approach to Sinus Tachycardia

REBEL Core Cast 136.0: A Simple Approach to the Tachypneic Patient

REBEL Core Cast 135.0: A Simple Approach to Hypoxemia (vs. Hypoxia)

REBEL Core Cast 134.0 – Acetaminophen Toxicity

REBEL Core Cast 139.0: Pneumothorax Decompression

Broaden Your Tension Pneumo Triggers

Confirm With Point-Of-Care Ultrasound

Problems With Classic Needle Site

🧭 REBEL Rundown

📌 Key Points

📝 Introduction

⏰ Highlights

📚 References

👤 Associate Editor

Anand Swaminathan

MD, MPH

🔎 Your Deep-Dive Starts Here

REBEL Core Cast 139.0: Pneumothorax Decompression

REBEL Core Cast 137.0: A Simple Approach to Sinus Tachycardia

REBEL Core Cast 136.0: A Simple Approach to the Tachypneic Patient

REBEL Core Cast 135.0: A Simple Approach to Hypoxemia (vs. Hypoxia)

REBEL Core Cast 134.0 – Acetaminophen Toxicity

Street Medicine: Compassionate Care for the Unhoused