Click illustration to enlarge.

When treating a tension pneumothorax, place the needle and catheter above the third rib, about 2 inches from the edge of the breastbone. (Click illustration to enlarge.)

by James Hubbard, MD, MPH

In my “What to Do for a Collapsed Lung” post, I promised future information on what to do for one of a collapsed lung’s most dangerous variants, a tension pneumothorax. So here it is.

This post covers an advanced procedure, but the procedure can save a life. If medical personnel aren’t able to get to the victim, you’ll likely be the only one around who’s even heard of this technique. So stay with me …

The Scenario

Your buddy’s been stabbed in the chest. You’ve taped up the chest wound as best you can—sealed it with petroleum jelly and gauze, as described in the collapsed-lung post, so air doesn’t get sucked in through it. But the ambulance isn’t coming anytime soon and your buddy is getting worse fast.

You check her over one more time, looking for things like bleeding or other wounds that could be causing her to go downhill. You find none.

You listen to her chest again. Just like with any pneumothorax (collapsed lung), there are no breath sounds on the side of the wound. But her pulse is going around 120 beats per minute and getting weaker. (You know that the regular rate is around 100 max.) She’s very lethargic and fading fast.


Okay, you already suspect she has a pneumothorax, and you’ve sealed the wound that caused it, but she’s getting so much worse. Why?

Fast, weak pulse; trauma. Could have internal bleeding. Even if she does, you can’t do anything about that here.

Is there anything you’re missing? What about a tension pneumothorax?

What Is a Tension Pneumothorax?

A regular pneumothorax occurs when air gets between a lung and the chest wall causing the lung to collapse.

A tension pneumothorax is a life-threatening variant. With every breath, air sucks into the chest cavity through the wound, but the wound is such that air can’t get back out. It’s a one-way valve going the wrong way.

My guess is this is what your friend has. The tension pneumo has caused pressure on the heart and may affect it to the point that she could die.

You’ve sealed the outside wound with a dressing to prevent air from getting in, but either too much air got in already or there’s a different leak coming from an internal wound to the lung (which you can do nothing about).

Just to make sure your dressing is not holding the air in, you take it off and hope for the hissing sound of releasing pressure.

No such luck, so you seal it back up. This time, though, you only tape down three sides, leaving one side open just in case some air from the chest needs to escape.

She’s getting worse by the minute.

The only other option is to stick another hole in the chest to allow the air to escape.

How to Perform a Needle Decompression
Needle and catheter set sold by North American Rescue. The catheter is the transparent instrument to the right of the needle. The needle goes inside the catheter. The orange tip on the catheter keeps it from sliding all the way into the body. (Image copyright North American Rescue. Click to enlarge.)

Needle and catheter set sold by North American Rescue. The catheter is the transparent instrument to the right of the needle. The needle goes inside it. The flexible catheter’s orange tip keeps it from slipping all the way into the body. (Image copyright North American Rescue. Click to enlarge.)

Fortunately, you’ve added to your car’s emergency kit one of the advanced supplies I recommend, a large-bore, hollow, 3.25-inch needle with a catheter.  (You could alternately store a 2-inch, but in some people there’s too much muscle and fat for it to get into the chest cavity.) You’ve also gotten something to clean the skin with, such as Betadine, alcohol, antiseptic wipes, or clean water.

Now you’ll perform the procedure:

  1. Find the third rib: On the side of the injury, near the breastbone, press on the chest and find the rib just below the collarbone. That’s called the second rib. (The first rib lies beneath the collarbone.) Now feel down for the third rib.
  2. At the third rib, move out about 2 inches from the edge of the breastbone (that’s approximately at the nipple line, vertically). This is where you’ll be working.
  3. Clean the area you just identified.
  4. Stick the needle (in the catheter) straight in at a 90 degree angle above the third rib. (Going above the rib avoids blood vessels that reside underneath each rib.)
  5. Slowly push the needle deeper until you hear a hiss of air. Stop.
  6. Pull out the needle, and continue pushing the catheter in a little farther. (It’s flexible and less likely to puncture the lung.)
  7. Tape the catheter to the chest to keep it in place.

If you only have a needle and no catheter, the procedure is the same, but be sure to stop the needle as soon as you hear a hiss. Don’t push it in farther or you might puncture the lung. Also, tape the needle to the chest well or take it out because unlike with a catheter, there’s nothing to stop it from slipping all the way into the body.

Warning: This Is Potentially Dangerous

Although this procedure can save a life, it is fraught with potential complications. Even in expert hands there could be serious internal bleeding if a blood vessel is damaged. The lung could get punctured. And as with any open wound, infection is a risk.

Needless to say, this should be done only if someone with a pneumothorax is getting worse really fast and you think they might die before expert help arrives.

What about you? Have you ever seen someone with such a serious chest emergency?

Special Access to Info About My New Online Course

The Survival Doctor Emergencies Training CourseI have a new video course that I’ll debut on September 30. It’s over a year in the making, and I’ve crafted it especially for my readers who want learn to save a life with confidence.

It’s called The Survival Doctor’s Emergencies Training Course, and it’s an online video course where I teach you exactly how to recognize and treat some of the most common life-threatening problems you’re likely to encounter. … But more on that in a second.

Many of us concentrate on food and water storage, shelter, and protection but neglect preparing on what to do if we get sick or hurt. It’s almost inevitable and could seriously hinder you from all else. Plus, health knowledge is something you’ll use even if you’re never in a situation to use the materials you’ve prepared.

If you’re not interested now, that’s totally okay. I realize the course isn’t right for everyone. But if you want to develop lifesaving techniques to the point where they’re virtually a reflex for you to do, I encourage you to sign up for my early-bird list:

Update: The course has launched! See it here.