TENSION

PNEUMOTHORAX
Contents
Case Scenario
Tension Pneumothorax
• Tension pneumothorax Diagnosed clinically, before the
chest x-ray is obtained.

• ALTHOUGH THE CLASSIC PRESENTATION

INCLUDES
• Distended neck veins,
• Hypotension or evidence of hypoperfusion,
• Diminished or absent breath sounds on the affected
side,
• and Tracheal deviation to the contralateral side
• one or more of these elements may be absent in the
presence of hypovolemia.

• PERFORM IMMEDIATE NEEDLE DECOMPRESSION

Tension Pneumothorax
Clinical Presentation
Differential Diagnosis
Chest X-ray
• In critically ill patients, when they cannot be moved to an
erect position, look for the deep sulcus sign, a deep
lateral costo-phrenic angle, on the affected side.
 Management
Resuscitation
• Trauma ►► ABC

• 100% oxygen ► ↑ pleural air absorption.

• Upright positioning may be beneficial

Management
 NEEDLE DECOMPRESSION
• The most common approach to needle decompression is
to introduce a 14-gauge IV needle and catheter into the
pleural space in the mid- clavicular line just above the rib
at the second intercostal space
• An anterior midclavicular approach is important
because this is the shortest distance from the skin
to the pleura, avoids the internal mammary
vessels that are located approximately 3 cm
lateral to the sternal border, and avoids
mediastinal vessels.
 Cont.…
• A rush of air exiting the pleural space may be audible
and is diagnostic of a pneumothorax.
• Needle depression converts the tension pneumothorax
into an open pneumothorax; needle decompression is a
temporizing measure and should be followed promptly
with tube thoracostomy.
• If the patient’s hemodynamics fail to improve
following decompression, consider other causes
of
• hypoperfusion, including pericardial tamponade.
Summary
 REFERENCES
• Tintinalli’s Emergency Medicine A Comprehensive Study
Guide 8th