How to decompress a tension pneumothorax
Other platforms explain it with text and video. In VMS you practice it on the patient.
Tension pneumothorax kills quickly. Decompression is lifesaving when done by trained providers.
Step by step
Recognize
Severe distress, absent breath sounds on one side, low blood pressure, distended neck veins; tracheal shift is late. [1]
Site
Second intercostal space midclavicular line, or fourth to fifth space at the anterior to mid axillary line, per protocol. [1]
Prepare
Clean the skin; large-bore needle long enough for the chest wall. [1]
Insert
Just over the top of the lower rib, until a rush of air. [1]
Secure
Leave the catheter, remove the needle. [1]
Reassess
Breathing and blood pressure; repeat if it recurs. [1]
Common errors
- Below the rib (vessels).
- Too short a needle.
- Not reassessing.
Practice it in VMS
In VMS you do this on the patient, not on paper: every step goes on the checklist with a score, and in Teach mode Blocky tells you what comes next.
VMS cases that train this skill
Sources
Facts and steps follow NASEMSO National Model EMS Clinical Guidelines; NREMT psychomotor skill sheets (EMT and Paramedic). VMS is not affiliated with these organizations. Updated: 2026-10-11.