Tension pneumothorax

Question 1

What may convert a pneumothorax to a tension pneumothorax?

Answer 1

positive pressure ventilation

Question 2

What percentage of patients in traumatic cardiac arrest have a tension pneumothorax?

Answer 2

13%

Question 3

What are the clinical signs of a tension pneumothorax?

Answer 3

• respiratory distress or hypoxia (prior to arrest)
• haemodynamic compromise (prior to arrest)
• absent breath sounds on auscultation
• chest crepitations
• subcutaneous emphysema
• tracheal deviation
• jugular venous distension

Question 4

What are the methods of treatment for a tension pneumothorax?

Answer 4

• needle decompression
• open thorcostomy
• clamshell thoracotomy

Question 5

How is needle decompression be performed?

Answer 5

Insert a needle perpendicular to the chest wall in either the 2nd intercostal space (just above the third rib) or the 4th/5th intercostal space in the mid-axillary line

you should use a specific non-kinking needle

Question 6

How is an open thoracostomy performed?

Answer 6

incision made in the chest wall (5th intercostal space mid-axillary line) followed by dissection into the pleural space

A chest drain should be sited at return of rosc