Tension pneumothorax

Tension pneumothorax

A tension pneumothorax develops when a ‘one-way valve’ air leak occurs either from the lung or

through the chest wall.

Etiologies are traumatic (e.g. rib fractures, chest stabbing), mechanical ventilation i.e. PPV (secondary due to barotrauma) and central line placement.

Presents with sudden onset dyspnea, tachypnea, hypotension and tachycardia.

Examination findings:- 
1. Decreased breath sounds on the affected side.
2. Hyperresonance to percussion. 
3. Tracheal deviation to opposite side.
4. JVP is elevated (i.e. JVD). 

Diagnosis:-

1. Chest x-ray shows a collapsed lung (with absence of lung markings), mediastinal shift away from the affected side, tracheal deviation to opposite site, hyperinflated hemithorax and absence of vascular markings on the affected side.

2. CT scan of the chest.

Management:-
1. Maintain ABC.
2. “Insertion of a large bore cannula into the second intercostal space in the midclavicular line” followed by “Chest tube placement in the triangle of safety”.