Tension pneumothorax

Background

• Death occurs from hypoxic respiratory arrest (V-Q mismatch), not circulatory arrest

Diagnosis

• Diminished or absent breath sounds
• Hypotension or e/o hypoperfusion
• Distended neck veins
  • May not occur if pt is hypovolemic
• Tracheal deviation
  • Late sign

Differential Diagnosis

Pneumothorax Types

The pleural cavity is normally a potential space, in which air collects in a pneumothorax.

• Tension pneumothorax
• Spontaneous pneumothorax
  • Catamenial pneumothorax
• Traumatic pneumothorax
  • Iatrogenic pneumothorax

Thoracic Trauma

• Airway/Pulmonary
  • Bronchial injury
  • Diaphragmatic trauma
  • Hemothorax
  • Pneumomediastinum
  • Pulmonary contusion
  • Tracheal injury
  • Trachobronchial injury
  • Traumatic pneumothorax
    • Tension pneumothorax
• Cardiac/Vascular
  • Cardiac injury
    • Blunt cardiac injury
      • Cardiac contusion
      • Commotio cordis
    • Penetrating cardiac injury
    • Cardiac tamponade
  • Traumatic aortic transection
• Musculoskeletal
  • Clavicle fracture
    • Clavicle fracture (peds)
  • Rib fracture
    • Flail chest
  • Scapular fracture
  • Scapulothoracic dissociation
  • Sternoclavicular dislocation
  • Sternum fracture
  • Thoracic and lumbar fractures and dislocations
• Other
  • Esophageal injury or Perforation
  • Pneumomediastinum
  • Pneumopericardium
  • Traumatic asphyxia

Treatment

• Immediate needle decompression if unstable
  • 14ga IV in midclavicular line just above the rib at the second intercostal space
• Always followed by Chest Tube placement

See Also

• Pneumothorax (main)
• Chest Tube
• Thoracentesis
• Thoracic Trauma
• Hemothorax

Source

• Roberts and Hedges Clinical Procedures in Emergency Medicine
• Rosen's
• American College of Chest Physicians Consensus Statement