Tension Pneumothorax

Question 1

What happens in a tension pneumothorax?

Answer 1

The damaged area of lung leaks air out into the pleural space on each inspiration

It does not permit the air to exit from the chest on expiration

Intra thoracic pressure continues to rise on the affected side, collapsing the lung and putting increased pressure on the heart and great vessels and opposite lung.

Question 2

Signs and symptoms

Answer 2

Apprehension/ aggitation

Distended neck veins

Trachael displacement toward normal side

Shock; skin cold and clammy

Increasing cyanosis

Air hunger

Decreased chest sounds/ absent

Chest on affected side will appear to have reduced/ no movement

Hyper resonance on percussion

Tachycardia

Question 3

Management of a tension pneumothorax

Answer 3

Assess observations and chest wall

Manage A and B

I. P. P. V. If required

Needle thoracocentisis

Rapid evacuation

Continuous monitoring/ re assessment en route

Question 4

A. What is the first site you should attempt for chest decompression

B. Why

Answer 4

A. Mid- clavicular line, second inter- costal space

B. Immobilsation of arms, less chance of catheter becoming displaced

Question 5

What should you use for chest decompression

Answer 5

14g cannula, orange

Question 6

What is the second site you should attempt for needle chest decompression

Answer 6

5th intercostal space, anterior to mid auxiliary line

Question 7

What are the complications of chest decompression

Answer 7

Injuries to the heart which may result into haemorrhage

Laceration of vessels

Creating a pneumothorax if one is not actually present

Laceration of lung

Risk of infection