Tension Pneumothorax
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Contents |
Etiology
- trauma (blunt or penetrating)
- barotrauma ( auto-PEEP)
- central venous catheter placement
- subclavian catheter
- internal jugular catheter
- conversion of simple pneumothorax to tension pneumothorax
- chest compressions during cardiopulmonary resuscitation
- pneumoperitoneum
- fiberoptic bronchoscopy with closed- lung biopsy
- markedly displaced thoracic spine fractures
- acupuncture has been reported to result in pneumothorax.6,7,8
- colonoscopy & gastroscopy (case reports)
- percutaneous tracheostomy [3]
Pathology
Clinical-manifestations
- agitation
- progressive hypoxia
- hypotension
- for patients on mechanical ventilation, especially with PEEP, elevation of plateau airway pressure with similar elevation in peak airway pressure concurrent with a decrease in tidal volume, strongly suggests tension pneumothorax
- lack of breath sound on affected side (unilateral)
- tracheal deviation
Diagnostic-procedures
- pulse oxymetry may show falling SaO2
- electrocardiogram:
- electromechanical dissociation may occur
Radiology
- diagnosis is confirmed by chest radiograph
- do not wait for chest X-ray unless diagnosis uncertain
Complications
- hemodynamic compromise ( cardiogenic shock) may occur
Management
- immediate therapeutic intervention is indicated
- administer oxygen (high concentration)
- needle decompression
- 2nd intercostal space, over 3rd rib ( arteries, veins, nerve run under rib)
- patients on mechanical ventilation: minimize airway pressure
More General Terms
References
- Introduction to Clinical Imaging, Radiology Syllabus, UCSF, 1993
- Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, American College of Physicians, Philadelphia 1998, 2006, 2009
- Bjerke S eMedicine: Tension Pneumothorax [1]
