Emergency - Tension pneumothorax

Question 1

What are the signs of a tension pneumothorax?

Answer 1

• B
  
  • tracheal deviation away from the side of the pneumothorax
  • unilateral expansion of the chest wall
  • subcutaneous emphysema
• C
  
  • tachycardia
  • hypotension

Question 2

What is the immediate management of a tension pneumothorax?

Answer 2

Early needle decompression (thoracocentesis - grey cannula in 2nd ICS mid-clavicular line) followed by chest drain insertion (5th ICS anterior axillary line) is needed.

Be aware that needle decompression may fail due to inadequate needle length. In the ventilated patient, thoracostomy (a surgical hole in the chest wall and pleura) may be quicker to do and more effective for decompressing.

Question 3

CXR before or after management?

Answer 3

BEFORE !!

Question 4

Why is there hypotension in a tension pneumothorax?

Answer 4

• A lung parenchymal flap is created, usually by thoracic trauma
• This acts as a one way valve and allows pressure to rise in the mediastinum
• This reduces venous return to the heart and since preload is reduced, cardiac output is reduced
• This presents as obstructive shock and can lead to cardiorespiratory arrest