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

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

Management

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

{{familytree | F01 | | | | F02 | | | | | | | | | |F01=Confirm diagnosis
Imaging studies
❑ Chest x-ray

❑ Air in the pleural cavity

❑ Contralateral deviation of mediastinum

❑ Increased thoracic volume

❑ Ipsilateral flattening of heart border

❑ Midiaphragmatic depression

❑ Chest CT scanning

❑

❑

|F02=Emergent chest drain
❑ Aseptic preparation

❑ Use two alcohol-based skin disinfectant

❑ Use 14-16 G intravenous cannula
❑ Site: 2nd rib space- mid clavicular line

Characterize the symptoms: ❑ Breathlessness ❑ Chest pain ❑ Cyanosis ❑ Sweating ❑ Anxiety ❑ Fatigue ❑ Air way pressure alarm: if on mechanical ventilation

Examine the patient: Vital signs ❑ Respiratory rate: ❑ Severe tachypnea ❑ Heart rate: ❑ Tachycardia ❑ Blood pressure ❑ Hypotension Focal chest examination Inspection ❑ Reduced lung expansion on the affected side ❑ Enlarged involved hemithorax ❑ Jugular venous distension Palpation ❑ Trachea shifted to the opposite side ❑ Decreased tactile vocal fremitus Percussion ❑ Hyperresonance Auscultation ❑ Diminished breath sounds on the affected side

First aid: ❑ Airway, breathing, and circulation ❑ Sucking chest wounds immediately coveraged with an occlusive or pressure bandage ❑ 100% oxygen. Administration

Categorize the Patient

Hemodynamically Stable

Hemodynamically Unstable

Do`s

• Serial chest radiographs every 6 hrs on the first day after injury to rule out pneumothorax is ideal.

References

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