Tension pneumothorax is a life-threatening condition where air accumulates in the pleural space. The mechanism involves a one-way valve effect, allowing air to enter during inhalation but preventing its escape during exhalation. This leads to lung collapse, increased chest pressure, hypoxia, mediastinal shift, and impaired venous return.

It causes traumatic cardiac arrest due to ipsilateral lung collapse, hypoxia, mediastinal shift, and impaired venous return.

Immediate action is crucial. Administer oxygen and perform needle decompression by inserting a large-bore needle into the 2nd or 3rd intercostal space. A rush of air confirms the diagnosis.

Common in:
– Ventilated patients
– Trauma patients
– Resuscitation scenarios (CPR)
– Acute asthma/COPD presentations
– Blocked or displaced chest drains
– Patients on non-invasive ventilation
– Hyperbaric oxygen treatment

Tension pneumothorax develops due to the build-up of air in the pleural space, caused by a one-way valve effect. This can result from traumatic chest injuries, medical procedures, or underlying lung diseases.

Consequences include progressive lung collapse, increased chest pressure, mediastinal shift, and compression of the heart and major blood vessels. This is a medical emergency requiring immediate intervention.

Risk factors include:
– History of lung disease (e.g., emphysema)
– Mechanical ventilation
– Chest trauma (including invasive medical procedures)
– Previous pneumothorax

Air Entrapment: Air enters the pleural space but cannot escape.

Pressure Increase: Leads to increased intrathoracic pressure.

Lung Compression: Compresses the affected lung.

Mediastinal Shift: Shifts the mediastinum to the opposite side.

Impaired Blood Flow: Affects heart and venous return.

Cardiovascular Compromise: Results in respiratory failure and cardiovascular compromise.

In tension pneumothorax, trapped air increases intrathoracic pressure, compresses the lung, causes a mediastinal shift, impairs venous return, leads to cardiovascular compromise, and results in respiratory failure.

Conditions with Similar Presentations:

– Simple pneumothorax

– Pulmonary embolism

– Acute asthma exacerbation

– Acute respiratory distress syndrome (ARDS)

– Cardiac tamponade

Prevalence: Relatively uncommon

Association: Often linked with trauma or medical interventions

Specific Data: Exact UK-specific epidemiological data not widely available

Nature: Regarded as a critical emergency condition needing swift recognition and intervention

Sudden-Onset Symptoms: Appear suddenly.

Severe Dyspnea/Tachypnea: Shortness of breath and rapid breathing.

Chest Pain/Tightness: Discomfort in the chest.

Tachycardia: Increased heart rate.

Cyanosis: Bluish discoloration of the skin.

Decreased Breath Sounds: On the affected side.

Hyper-resonant Percussion: On the affected side.

Distended Neck Veins: Visible swelling and raised JVP.

Pulsus Paradoxus: Pulse weakens during inhalation.

Tracheal Deviation: Away from the affected side.

Hemodynamic Instability: Fluctuations in blood pressure and circulation.

Severe Cases: May lead to cardiovascular collapse and loss of consciousness.

Diagnosis of tension pneumothorax is primarily clinical; immediate action is required, and treatment should not be delayed for imaging.

Chest X-ray may confirm the diagnosis by showing:

– Collapsed lung

– Mediastinal shift

– Hemi-diaphragmatic depression

– Ipsilateral flattening of the heart border

– Contralateral mediastinal deviation

CT scans provide more detailed imaging but are not needed for urgent diagnosis and should not delay immediate treatment.

1. Immediate Management:

– Needle decompression or chest tube insertion to relieve pressure and restore cardiac output.

2. Definitive Treatment:

– Pleurodesis, surgical repair, or monitoring for self-resolving cases.

3. Oxygen and Analgesia:

– Administer high-flow oxygen (SpO₂ >96%) and provide adequate analgesia.

4. Prophylactic Antibiotics:

– Consider for severe trauma cases to prevent complications after chest drain insertion.

5. Chest Decompression:

– Perform immediately if suspected; insert a cannula into the appropriate intercostal space.

6. Chest Drain Insertion:

– Insert within the safe triangle and leave in place until no air escapes and the lung re-expands.

7. Surgical Intervention:

– Consider surgery if air leakage persists after 2-4 days.

Favorable prognosis with prompt treatment: Generally good outcomes with appropriate management.

Delayed treatment risks: Can lead to cardiac arrest, respiratory failure, and death.

Early intervention: Improves outcomes and reduces long-term complications.

Key takeaway: Prompt recognition and intervention are critical for a positive prognosis.

Potential complications include:

– Cardiac arrest

– Hypoxia

– Respiratory failure

– Tension mediastinal shift

– Irreversible lung damage

– Fatal outcomes in rare cases

• Cardiac arrest

• Respiratory failure

• Death