Tension Pneumothorax

Question 1

What is the pathophysiology of tension Pneumothorax? (4)

Answer 1

• Air trapping in intrapleural space
• Lung defect acts as one way valve
• pressure builds— compress the lungs –shifts the mediastinum
• high intrathoracic pressure — decreased Vascular resistance — kinking of SVC AND IVC – Obstructive shock

Question 2

What are the signs of tension pneumothorax? (7)

Answer 2

• PE:
  • Respiratory distress
  • Hypotension
  • Tachycardia
  • Distended neck vein
  • Tracheal shift to opposite side
  • Hyper resonance on percussion
  • Reduced breath sounds

Question 3

What sign on US can confirm tension pneumothorax?(2)

Answer 3

• ABSENT Sliding sign:
  • The presence of lung sliding indicates that the lung is fully inflated at the site of probe placement on the chest wall, so there is no pneumothorax at that examination site
• Barcode sign

Question 4

Immediate Treatment of tension Pneumothorax?

Answer 4

•Immediate needle thoracocentesis (hissing sound)
-5th ICS, ant. to mid axillary line
-Large bore brannula: Orange 🧡, 16G

• Followed by chest tube insertion
- inside safety triangle

Question 5

What are the borders of the safety triangle?

Answer 5

Anteriorly: Pectoralis major
Interiorly: 5th ICS
Posterior: Latissimus dorsi