Tension pneumothorax
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
Ideally is a clinical diagnosis treated emergently (without study delay)
- CXR
- Ultrasound
- Absence of lung sliding; absence of seashore (M-mode)
- CT chest
- Most sensitive
Treatment
- Immediate needle decompression
- 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]