Tension pneumothorax

This chest Xray shows a deviated trachea, hyperexpansion on the right, and a mediastinal shift to the left.

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.