Question

Discuss tension pneumothorax.

Answer 1

A tension pneumothorax is a life threatening condition that develops due to accumulation of air in pleural space/cavity under positive pressure, compressing the lungs and decreasing venous return to heart.

Pathophysiology :-

Tension pneumothorax develops when a lung or a chest wall injury is such that it allows air into the pleural space but not out of it, acts like a one-way valve. This leads to accumulation of air and compression of lung which eventually shift the mediastinum, compress contralateral lung, increase intrathoracic Pressure. It will result in decrease venous return causing shock.

Clinical features :-

• Hypotension.
• Unilateral absence/diminished breath sounds.
• Distended neck veins.
• Contralateral tracheal deviation.
• Shock due to decrease venous return.

Diagnosis :-

?Should be diagnosed clinically so that treatment is not delayed for radiographic confirmation.

?Most common features - hypotension, neck vein distension and respiratory distress.

Tension pneumothorax can be differentiated from cardiac tamponade clinically by former having unilateral absence of breath sounds and hyperresonace to percussion.

? For confirmation Chest X- ray can be done.

? Ultrasound of lung.

Treatment :-

Immediate treatment.

? Needle decompression followed by tube thoracostomy. A large bore needle (14 or 16 gauge) is inserted into 2nd intercostal space along mid-clavicular line so air will gush out making it simple pneumothorax. Then thoracostomy should be performed immediately.