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Tension Pneumothorax for Veterinary Instructors

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Tension Pneumothorax for Medics

Most medics are relatively familiar with Tension Pneumothorax and needle decompression in the human patient.  We remind students of the progressive nature of the injury, increasing as the abnormal collection of air becomes more severe with each breath.  In humans this progression typically becomes evident within about 15min and we expect similar results in dogs.

There are two primary differences between the human and canine patient.

Dogs have a fenestrated mediastinum

This is significant because humans have a complete mediastinum and so there is typically unilateral failure. As a result many of the human assessment techniques rely on asymmetric findings such as uneven expansion of the chest. Since the dogs have a fenestrated mediastinum they are more likely to have bilateral lung failure. However, while the mediastinum is fenestrated, it does not allow perfect communication between both sides of the chest. So, this means that dogs will often need to have both sides of the chest decompressed.

“Monitor for Distress, Monitor for Collapse, THEN Decompress”

This is a tough one. In humans, while there is a range of opinions of how early to decompress, everyone would agree that we would not wait for a human to actually collapse.  So it is very difficult to convince a medic that can accurately assess the progression on Tension Pneumothorax in their canine patient to wait for the dog to collapse. 

Here are the differences that make it important to actually wait for the collapse.

  1. Harder to Communicate with Dogs to Stay Still: 
    This one is easy. Dogs in general move much more than their human counterparts.  And, I can tell my human patient to stay still because I’m going to stick s big needle in their chest and movement will be bad.  Most people will comply pretty quickly, especially given the respiratory distress they are experiencing. 

  2. Needle Stays In Place for entire Canine Procedure:
    Because the skin movement over the SubQ space is likely to kink a catheter, the canine procedure requires that we leave the stylet in place to optimize successful evacuation.  Also the needles which most providers are carrying are 3.25″ long which has a significant range inside the body if the dog was to move.
And so the pairing of significantly less control of the patient with significantly greater risk of doing damage results in the requirement to “Monitor for Distress, Monitor for Collapse, and THEN Decompress”

GDV Video

PS – did you catch the language error?  This film was created before we evolved to saying “Greatest Tympany” instead of highest tympany.  We are working on updating these, as they are quite early in our curriculum development.