Tension pneumothorax resident survival guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Tension pneumothorax is a medical emergency caused by accumulation of air in the pleural cavity. Air enter the intrapleural space through the lung parenchyma, or through a traumatic communication from the chest wall.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. Tension pneumothorax is a life-threatening condition and must be treated as such irrespective of the underlying causes.

Common Causes

• Blunt trauma
• Central venous catheter
• Mechanical ventilation
• Cardiopulmonary resuscitation
• Emphysema
• Chronic obstructive pulmonary disease
• Asthma

Management

Shown below is an algorithm depicting the management of tension pneumothorax.

Characterize the symptoms: ❑ Breathlessness ❑ Chest pain ❑ Cyanosis ❑ Sweating ❑ Anxiety ❑ Fatigue

Identify existing risk factors: ❑

Examine the patient: Vital signs ❑ Sever tachypnea ❑ Tachycardia ❑ Hypotension Focal chest examination ❑ Reduced lung expansion on the affected side ❑ Enlarged involved hemithorax ❑ Trachea shifted to the opposite side ❑ Hyper-resonance ❑ Decreased tactile vocal fremitus ❑ Jugular venous distension ❑ Diminished breath sounds on the affected side

References

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