Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Updated: Dec 22 2021

Tension Pneumothorax

Images ptx.jpg
  • Snapshot
    • A 56-year-old male with a history of chronic obstructive pulmonary disease presents with pleuritic chest pain and trouble breathing. Vital signs are significant for a blood pressure of 88/54 mmHg and a pulse of 115/min. On exam, there is jugular venous distension, decreased breath sounds on the right side, with wheezes. A chest radiograph is obtained.
  • Introduction
    • Tension pneumothorax results from positive pressure build-up secondary to a flap valve mechanism (or one-way valve) resulting in total lung collapse
      • tracheal shifting to opposite end
      • expansion of chest wall
    • Increased intrathoracic pressure restricts cardiac output
      • may result in shock and death
    • Etiologies include
      • penetrating and blunt chest trauma
      • infection
      • positive-pressure mechanical ventilation
      • iatrogenic
        • placement of central venous line
        • epidural thoracic catheter placement
  • Presentation
    • Symptoms
      • acute-onset, unilateral, pleuritic chest pain
      • dyspnea/acute respiratory distress
      • syncope
    • Physical exam
      • tachypnea and tachycardia
      • unilateral decreased or absent breath sounds
      • hyperresonance
      • decreased or absent tactile fremitus
      • falling O2 saturation
      • deviated trachea
      • JVD
      • hypotension
      • subcutaneous emphysema
    • Ultrasound
      • fast with no radiation exposure
      • requires a bedside ultrasound readily available
      • guidance for tube placement
    • Chest radiography (CXR)
      • do not obtain CXR if tension pneumothorax is suspected - immediately decompress the pleural space
      • best observed in end-expiratory films
        • shows unilateral absence lung parenchyma
        • and contralateral mediastinal shift
  • Differential
    • Primary spontaneous pneumothorax, secondary pneumothorax, acute asthma, inhalation of foreign object, myocardial infarction, ruptured aortic aneurysm
    • Tracheobronchial rupture
      • if a recurrent pneumothorax that recurs after chest tube placement
  • Treatment/Management
    • Prevention
      • no preventive measures can be taken for initial insult
      • chest tube placement following needle decompression prevents recurrence
    • Non-operative
      • do not resolve spontaneously
        • unlike small, simple pneumothoraces
      • supplemental O2 therapy
        • following operative intervention may be required
    • Operative
      • immediate needle decompression
        • second intercostal space at the midclavicular line with 14 or 16-gauge needle
      • followed by chest tube placement
  • Complications
    • Shock and death if left untreated
  • Prognosis
    • Shock and death will result if not immediately recognized and treated
1 of 0
1 of 6
Private Note

Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options