Tension pneumothorax: Difference between revisions
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[[image: | [[image:tensionpneumothorax.jpg|right|thumb|300px|This chest [[Xray]] shows a deviated trachea, hyperexpansion on the right, and a mediastinal shift to the left.]] | ||
[[image:emergency.gif|left]] | |||
'''[[Medical Emergency]] - Tension pneumothorax can cause [[sudden death]]. When it happens, you gotta sort it!''' | |||
===Definition=== | ===Definition=== | ||
Like a regular [[pneumothorax]] but artificial valve in visceral pleura (one on the inside) means air goes into the space but not back into the lung. | |||
===Epidemiology=== | ===Epidemiology=== | ||
[[image:common.jpg]] | [[image:common.jpg]] | ||
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*Fill slightly with 0.9% saline | *Fill slightly with 0.9% saline | ||
*Insert into '''2nd intercostal space, mid-clavicular line''' | *Insert into '''2nd intercostal space, mid-clavicular line''' | ||
*Remove plunger - air will bubble through saline and you'll be able tell it's been successful | |||
After this has been done, replace the syringe with a chest drain. |
Latest revision as of 08:57, 4 June 2010
Medical Emergency - Tension pneumothorax can cause sudden death. When it happens, you gotta sort it!
Definition
Like a regular pneumothorax but artificial valve in visceral pleura (one on the inside) means air goes into the space but not back into the lung.
Epidemiology
Pathophysiology
Usually caused by a rupture of the pleura and can be sponatneous.
- Lung - asthma, TB, COPD, pneumonia, cancer, abscess, CF, fibrosis
- Non-lung - connective tissue: sarcoidosis; trauma: both iatrogenic and non-iatrogenic
If left, the pneumothorax will fill the chest and crush the heart and lungs causing cardiorespiratory arrest. This is bad, kills people and makes this condition an emergency.
Risk Factors
Having a pneumothorax, being a young thin man (like me, baby!).
Clinical Features
- Respiratory - shortness of breath, pleuritic chest pain, diminished breath sounds and hyperesonant over affected area, reduced chest expansion
- Cardiac - tachycardia, hypotension
- Neck - deviated trachea, distended neck veins
Investigations
If you suspect one DO SOMETHING STRAIGHTAWAY! GO STRAIGHT TO MANAGEMENT!
Management
Insert a chest drain:
- Use a large-bore (14-16G) needle and syringe
- Fill slightly with 0.9% saline
- Insert into 2nd intercostal space, mid-clavicular line
- Remove plunger - air will bubble through saline and you'll be able tell it's been successful
After this has been done, replace the syringe with a chest drain.