Pulmonology Book

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Tension Pneumothorax

Aka: Tension Pneumothorax
  1. Also See
    1. Simple Pneumothorax
    2. Open Pneumothorax
  2. Symptoms
    1. Sudden sharp Chest Pain
    2. Air Hunger
  3. Signs
    1. Unilateral absent breath sounds
    2. Hyperresonant chest to percussion
    3. Cyanosis
    4. Respiratory distress
    5. Tachycardia
    6. Hypotension
    7. Tracheal deviation to contralateral side
    8. Neck vein distention
  4. Imaging: Chest XRay
    1. Do not use XRay to diagnose a Tension Pneumothorax
    2. Confirm diagnosis by Chest XRay after decompression
  5. Precautions
    1. Tension Pneumothorax is a clinical diagnosis (not an imaging diagnosis)
    2. Do not obtain a Chest XRay prior to Needle Decompression (delays are lethal)
    3. Needle Decompression buys a small amount of time in which to place a Chest Tube for definitive management
  6. Management
    1. Emergent Needle Thoracentesis
      1. Insert 14 gauge angiocatheter (5 cm) over the top of the third rib in the mid-clavicular line
      2. Do not wait for Chest XRay
    2. Chest Tube
      1. Perform immediately after Needle Decompression
      2. Insert over the top of the 5th rib in the mid-axillary line

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