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Ann Emerg Med. 1993 May;22(5):863-6.

Needle thoracostomy fails to detect a fatal tension pneumothorax.

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Emergency Department, University of Pennsylvania, Philadelphia.

Erratum in

  • Ann Emerg Med 1993 Aug;22(8):1364.


Needle thoracostomy is an emergency procedure used to both diagnose and initially treat a tension pneumothorax. We report a case of fatal tension pneumothorax in an intubated patient with chronic obstructive pulmonary disease that was missed by this technique. A tension pneumothorax involving only the right middle and lower lobes was found at autopsy. The autopsy also suggested that needle thoracostomy was misleading because it sampled air from a noncommunicating bulla in the right upper lobe rather than from the pleural space. Tension physiology can exist with only localized collapse of a lung, and diagnostic needle thoracostomy can be falsely negative. When tension pneumothorax is strongly suspected, if empiric thoracentesis does not vent air under pressure, subsequent tube thoracostomy is indicated.

[Indexed for MEDLINE]

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