Questions and Answers
What are the general characteristics of tension pneumothorax? (Select all that apply)
What are three causes of tension pneumothorax?
Mechanical ventilation with associated barotrauma, CPR, trauma.
What are five clinical features of tension pneumothorax?
Hypotension, distended neck veins, trachea shift away from the pneumothorax on CXR, decreased breath sounds on the affected side, hyperresonance to percussion on the side of pneumothorax.
What is the treatment for a tension pneumothorax?
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If tension pneumothorax is suspected, what should you do first?
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Study Notes
General Characteristics of Tension Pneumothorax
- Air accumulates in the pleural space, acting as a one-way valve allowing air to enter but not exit.
- Positive pressure in the pleural space causes the affected lung to collapse and shifts the mediastinum away from the pneumothorax side.
Causes of Tension Pneumothorax
- Mechanical ventilation can lead to barotrauma resulting in tension pneumothorax.
- Cardiopulmonary resuscitation (CPR) may inadvertently cause the condition.
- Direct trauma, such as penetrating injuries, can also result in air accumulation.
Clinical Features of Tension Pneumothorax
- Hypotension occurs due to impaired cardiac filling from compression of great veins.
- Distended neck veins are observed as venous return to the heart is obstructed.
- A tracheal shift can be detected on chest X-ray, moving away from the affected side.
- Decreased breath sounds are noted on the side where the pneumothorax is present.
- Hyperresonance is noted upon percussion on the affected side indicating trapped air.
Treatment of Tension Pneumothorax
- Immediate medical intervention is critical; failure to relieve tension can result in death from hemodynamic instability.
- Chest decompression is performed using a large bore needle in the 2nd or 3rd intercostal space at the mid-clavicular line, followed by the placement of a chest tube.
Immediate Action if Tension Pneumothorax is Suspected
- Perform immediate decompression of the pleural space with a large bore needle.
- Do not obtain a chest X-ray prior to decompression if tension pneumothorax is suspected.
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