Tension Pneumothorax

Question 1

In which patients should there be a high degree of suspicion of a TPT?

Answer 1

1. Chest trauma
2. Ventilated pt
3. Suspected spontaneous pneumothorax

Question 2

What are the criteria for a simple pneumothorax? (3)

Answer 2

Any of the following:

1. Unequal breath sounds in the spontaneously ventilating pt
2. SPO2 <92% on RA
3. Subcutaneous emphysema

Question 3

What is the Mx for a simple pneumothorax?

Answer 3

1. O2 as indicated
2. Analgesia as indicated
3. Position upright if appropriate
4. Monitor for signs of TPT

Question 4

What are the criteria for a TPT? (8)

Answer 4

1. increased resp. distress in the awake pt
2. decreased SPO2 to <92% despite O2
3. decreased CS
4. poor perfusion or inc. HR +/- dec. BP
5. increased peak inspiratory pressure/stiff bag
6. decreased ETCO2
7. increased JVP
8. tracheal shift

+/- signs of a simple pneumothorax

Question 5

What are the two Mx arms of the TPT guideline, and how are they both managed?

Answer 5

Cardiac arrest imminent
- BP <70, GCS<10 then decompress immediately (ALS)

Cardiac arrest not imminent
- Monitor for deterioration (ALS), decompression (MICA)