B. Insertion of a cannula into the left second intercostal space – Explanation

The features described is diagnostic of left sided tension pneumothorax

Tension Pneumothorax
Presentation
– Acute respiratory distress
– Hypotension
– Raised jugular venous pressure
– Tracheal deviation away from the pneumothorax side
– Reduced air entry on affected side

Management of a tension pneumothorax
If strong clinical suspicion, give high-flow oxygen and insert large-bore cannula
into
second intercostal space in midclavicular line on side of pneumothorax.
– Do not wait for a chest X-ray if patient seriously compromised or cardiac arrest
has occurred or if the diagnosis is clinically certain
– Hiss of escaping air confirms diagnosis
– Air should be aspirated until the patient is less distressed. Then insert a chest
drain in mid-axillary line, leaving the cannula in place until you have finished
and the underwater seal is bubbling satisfactorily

Comparing simple and tension pneumothorax

PNEUMOTHORAX TYPES
Primary spontaneous pneumothorax

• Occurs without an apparent cause

Secondary spontaneous pneumothorax

• Occurs in presence of existing lung pathology e.g. COPD

Simple pneumothorax

• Non-expanding collection of air around the lung

Tension pneumothorax

• Expanding collection of air around the lung

Think of tension pneumothorax as a “one way valve” where air is allowed to enter
around the lung but cannot escape it. Although this is not entirely true because
air can actually still escape a little, hopefully this analogy gives you the idea of a
tension pneumothorax.