Tension pneumothorax

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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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Nội dung Text: Tension pneumothorax

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 natural ly. 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. Tension pneumothorax is a clinical diagnosis that now is more readily recognized because of improvements in emergency medical services (EMS) and the widespread use of chest x-rays (see image below).
This picture shows a chest radiograph with 2 abnormalities: (1) tension pneumothorax and (2) potentially life-saving intervention delayed while waiting for x-ray results. Tension pneumothorax is a clinical diagnosis requiring emergent needle decompression, and therapy should never be delayed for x -ray confirmation. Problem Air trapped in the pleural cavity and causing shifts of the intrathoracic structure is a life-threatening emergency. Promptly recognizing this condition saves lives, both outside the hospital and in a modern intensive care unit (ICU). Because tension pneumothorax occurs infrequently and has potentially devastating effects, a high index of suspicion and knowledge of basic emergency thoraci c decompression are important for all healthcare personnel. Although some authors are now questioning the pathophysiology of tension pneumothorax, no animal models or randomized prospective trials have provided any evidence that our understanding of the cause, effects, and treatment of the disease should be changed. Presentation Clinical interpretation of the presenting signs and symptoms of a tension pneumothorax is crucial for diagnosing and treating the condition.
* Early findings o Chest pain o Dyspnea o Anxiety o Tachypnea o Tachycardia o Hyperresonance of the chest wall on the affected side o Diminished breath sounds on the affected side * Late findings o Decreased level of consciousness o Tracheal deviation toward the contralateral side o Hypotension o Distention of neck veins (may not be present if hypotension is severe) o Cyanosis
These findings may be affected by the volume status of the patient. In hypovolemic trauma patients with ongoing hemorrhage, the physical findings may lag behind the presentation of shock and cardiopulmonary collapse. In nonventilated patients, the diagnosis of tension pneumothorax often requires a high level of suspicion and the presence of decreased or absent breath sounds on the affected side. In ventilated patients, the physician may begin to suspect tension pneumothorax when increased pleural pressures necessitate an increase in peak airway pressure in order to deliver the same tidal volume. Decreased expiratory volumes secondary to air leakage into the pleural space and increased end-expiratory pressure, even after discontinuation of PEEP, are 2 other signs of tension pneumothorax in these patients. Occasionally, the development of tension pneumothorax may be delayed for hours to days after the initial insult, and the di agnosis may become evident only if the patient is receiving positive-pressure ventilation. Tension pneumothorax has been reported during surgery with both single and double lumen tubes. Increased pulmonary artery pressures and decreased cardiac output or c ardiac index are evidence of tension pneumothorax in patients with Swan -Ganz catheters.