Regional Emergency Medical Advisory Committee of New York City Prehospital Advanced Life Support Protocols Copyright January 1996 (3/96)

1. Confirm the need for Needle Decompression:
   • Respiratory distress
     • dyspnea;
     • tachypnea;
     • cyanosis; and/or
     • chest pain;
   • Absent or decreased breath sounds on the affected side; and
   • A deviated trachea away from the side of the injury.
2. Administer high concentration oxygen.
3. Identify the second intercostal space on the mid-clavicular line on the same side as the Pneumothorax.
4. Cleanse the overlying skin with Povidone Iodine solution.
5. Insert a #l4 gauge, 3-6 cm long, over-the-needle catheter into the skin above the third rib and direct it just over the rib into the interspace. Use an 18 - 20 gauge over-the-needle catheter for pediatric patients.
6. Insert the catheter through the parietal pleura until air exits under pressure.
7. Remove the needle and leave the plastic cannula in place until it is replaced in the Emergency Department.
8. Attach a flutter valve to the end of the plastic cannula and secure the cannula for transportation.

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