• If there are indications of tension pneumothorax and the patient is hemodynamically unstable, decompress the chest with a 14-gauge, 3 ¼” angiocaths placed in the second or third intercostal space in the mid-clavicular line (MCL). The MCL is parallel to the sternum, extending down from the midpoint of the clavicle. Placement of a needle too high, too low, too medial, or too lateral increases the risk of complications. Tracheal deviation is a very late sign and therefore an unreliable indicator.

  •  3 ¼” angiocaths may not be available from emergency departments. EMS agencies may need to purchase them.


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