Tension pneumothorax

Tension pneumothorax is the accumulation of air under pressure in the pleural space. This condition develops when injured tissue forms a 1-way valve, allowing air to enter the pleural space and preventing the air from escaping naturally. Arising from numerous causes, this condition rapidly progresses to respiratory insufficiency, cardiovascular collapse, and, ultimately, death if unrecognized and untreated. Favorable patient outcomes require urgent diagnosis and immediate management.
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Tension pneumothorax Tension pneumothoraxTension pneumothorax is the accumulation of air under pressure in the pleuralspace. This condition develops when injured tissue forms a 1 -way valve, allowingair to enter the pleural space and preventing the air from escaping natural ly.Arising from numerous causes, this condition rapidly progresses to respiratoryinsufficiency, cardiovascular collapse, and, ultimately, death if unrecognized anduntreated. Favorable patient outcomes require urgent diagnosis and immediatemanagement.Tension pneumothorax is a clinical diagnosis that now is more readily recognizedbecause of improvements in emergency medical services (EMS) and thewidespread use of chest x-rays (see image below).This picture shows a chest radiograph with 2 abnormalities: (1) tensionpneumothorax and (2) potentially life-saving intervention delayed while waitingfor x-ray results. Tension pneumothorax is a clinical diagnosis requiring emergentneedle decompression, and therapy should never be delayed for x -rayconfirmation.ProblemAir trapped in the pleural cavity and causing shifts of the intrathoracic structure isa life-threatening emergency. Promptly recognizing this condition saves lives,both outside the hospital and in a modern intensive care unit (ICU). Becausetension pneumothorax occurs infrequently and has potentially devastating effects,a high index of suspicion and knowledge of basic emergency thoraci cdecompression are important for all healthcare personnel.Although some authors are now questioning the pathophysiology of tensionpneumothorax, no animal models or randomized prospective trials have providedany evidence that our understanding of the cause, effects, and treatment of thedisease should be changed.PresentationClinical interpretation of the presenting signs and symptoms of a tensionpneumothorax is crucial for diagnosing and treating the condition.* Early findingso Chest paino Dyspneao Anxietyo Tachypneao Tachycardiao Hyperresonance of the chest wall on the affected sideo Diminished breath sounds on the affected side* Late findingso Decreased level of consciousnesso Tracheal deviation toward the contralateral sideo Hypotensiono Distention of neck veins (may not be present if hypotension is severe)o CyanosisThese findings may be affected by the volume status of the patient. Inhypovolemic trauma patients with ongoing hemorrhage, the physical findings maylag behind the presentation of shock and cardiopulmonary collapse.In nonventilated patients, the diagnosis of tension pneumothorax often requires ahigh level of suspicion and the presence of decreased or absent breath sounds onthe affected side.In ventilated patients, the physician may begin to suspect tension pneumothoraxwhen increased pleural pressures necessitate an increase in peak airway pressurein order to deliver the same tidal volume. Decreased expiratory volumes secondaryto air leakage into the pleural space and increased end-expiratory pressure, evenafter discontinuation of PEEP, are 2 other signs of tension pneumothorax in thesepatients. Occasionally, the development of tension pneumothorax may be delayedfor hours to days after the initial insult, and the di agnosis may become evidentonly if the patient is receiving positive-pressure ventilation. Tensionpneumothorax has been reported during surgery with both single and doublelumen tubes.Increased pulmonary artery pressures and decreased cardiac output or c ardiacindex are evidence of tension pneumothorax in patients with Swan -Ganz catheters.