Tension Pneumothorax

Question 1

Essentials of Diagnosis:

Tracheal deviation away from the pneumothorax with respiratory distress and hypotension.

Answer 1

Tension Pneumothorax

Question 2

General Considerations:

Dx develops when a one-way valve air leak occurs from either the lung or the chest wall.

Air enters the pleural space but cannot escape.
* Increased intra-pleural pressure.
* Collapse of the lung.
* Shift of the mediastinal contents to the opposite side

Answer 2

Tension Pneumothorax

Question 3

Physical Findings:

• Respiratory distress, tachypnea, tachycardia.
• Hyper resonance to percussion.
• Decreased or absent breath sounds on auscultation.
• Trachea may be deviated away from the affected side.
• Neck veins may be distended except in the hypovolemic patient.

Answer 3

Tension Pneumothorax

Question 4

Lab/Imaging Findings:

Diagnosis is clinical, do not delay immediate treatment waiting to obtain X- ray for what dx.

Answer 4

Tension Pneumothorax

Question 5

Treatment:

-Ensure patient has an intact airway
-Oxygen
-If the airway is not intact, provide suctioning and intubation if necessary.
-Immediate needle thoracotomy followed by tube thoracotomy.
* Large bore (16ga or larger) IV catheter inserted into the second intercostal space at the mid clavicular line.
* This converts the Dx into a simple Pneumothorax until the chest tube can be placed.

Follow up will be performed by the treatment team after MEDEVAC.

Answer 5

Tension Pneumothorax

Question 6

Pt education is based on prevention
* Discontinued smoking.
* Future exposure to high altitudes.
* Flying non-pressurized aircraft.
* SCUBA diving.
Risk of recurrence is 50%.

Disposition:
* MEDEVAC

Complications:
* Pneumomediastinum
* Subcutaneous emphysema - also consider rupture of esophagus or bronchus.

Answer 6

Tension Pneumothorax