Tension pneumothorax: Difference between revisions
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*Death occurs from hypoxic respiratory arrest (V-Q mismatch), not circulatory arrest | *Death occurs from hypoxic respiratory arrest (V-Q mismatch), not circulatory arrest | ||
== | ==Clinical features== | ||
* | *Unilateral diminished or absent breath sounds | ||
*Hypotension or | *Hypotension or evidence of hypoperfusion | ||
*Distended neck veins | *Distended neck veins | ||
**May not occur if | **May not occur if patient is hypovolemic | ||
*Tracheal deviation | *Tracheal deviation | ||
**Late sign | **Late sign | ||
| Line 14: | Line 14: | ||
{{Thoracic trauma DDX}} | {{Thoracic trauma DDX}} | ||
{{SOB DDX}} | {{SOB DDX}} | ||
==Diagnosis== | |||
==Treatment== | ==Treatment== | ||
Revision as of 20:00, 13 May 2015
Background
- Death occurs from hypoxic respiratory arrest (V-Q mismatch), not circulatory arrest
Clinical features
- Unilateral diminished or absent breath sounds
- Hypotension or evidence of hypoperfusion
- Distended neck veins
- May not occur if patient is hypovolemic
- Tracheal deviation
- Late sign
Differential Diagnosis
Pneumothorax Types
Thoracic Trauma
- Airway/Pulmonary
- Cardiac/Vascular
- Musculoskeletal
- Other
Acute dyspnea
Emergent
- Pulmonary
- Airway obstruction
- Anaphylaxis
- Angioedema
- Aspiration
- Asthma
- Cor pulmonale
- Inhalation exposure
- Noncardiogenic pulmonary edema
- Pneumonia
- Pneumocystis Pneumonia (PCP)
- Pulmonary embolism
- Pulmonary hypertension
- Tension pneumothorax
- Idiopathic pulmonary fibrosis acute exacerbation
- Cystic fibrosis exacerbation
- Cardiac
- Other Associated with Normal/↑ Respiratory Effort
- Other Associated with ↓ Respiratory Effort
Non-Emergent
- ALS
- Ascites
- Uncorrected ASD
- Congenital heart disease
- COPD exacerbation
- Fever
- Hyperventilation
- Interstitial lung disease
- Neoplasm
- Obesity
- Panic attack
- Pleural effusion
- Polymyositis
- Porphyria
- Pregnancy
- Rib fracture
- Spontaneous pneumothorax
- Thyroid Disease
- URI
Diagnosis
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
Disposition
- Admit
Special Instructions
Flying
- Can consider flying 2 weeks after full resolution of traumatic pneumothroax[1]