Tension pneumothorax resident survival guide: Difference between revisions
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Imaging studies<BR> | Imaging studies<BR> | ||
❑ Chest x-ray<BR> | ❑ Chest x-ray<BR> | ||
:❑ Erect position in inspiration<BR> | |||
:❑ Air in the pleural cavity<BR> | :❑ Air in the pleural cavity<BR> | ||
:❑ Contralateral deviation of mediastinum<BR> | :❑ Contralateral deviation of mediastinum<BR> | ||
:❑ Increased thoracic volume<BR> | :❑ Increased thoracic volume<BR> | ||
:❑ Ipsilateral flattening of heart border<BR> | :❑ Ipsilateral flattening of heart border<BR> | ||
:❑ | :❑ Mid diaphragmatic depression<BR> | ||
❑ Chest CT scanning<BR> | ❑ Chest CT scanning<BR> | ||
❑ Ultrasonography<BR> | ❑ Ultrasonography<BR> | ||
</div> | </div> | ||
|F02=<div style="float: left; text-align: left; padding:1em;">''' | |F02=<div style="float: left; text-align: left; padding:1em;">'''Emergency chest drain'''<BR> | ||
❑ Aseptic preparation<BR> | ❑ Aseptic preparation<BR> | ||
:❑ Use two alcohol-based skin disinfectant<BR> | :❑ Use two alcohol-based skin disinfectant<BR> | ||
❑ Use 14-16 G intravenous cannula<BR> | ❑ Use 14-16 G intravenous cannula<BR> | ||
❑ Site: 2nd | ❑ Site: 2nd intercostal space- mid clavicular line<BR> | ||
</div>}} | </div>}} | ||
Revision as of 02:06, 12 March 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Tension pneumothorax is a medical emergency caused by accumulation of air in the pleural cavity. Air enter the intrapleural space through the lung parenchyma, or through a traumatic communication from the chest wall.
Causes
Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. Tension pneumothorax is a life-threatening condition and must be treated as such irrespective of the underlying causes.
Common Causes
- Mechanical ventilation
- Blunt trauma
- Central venous catheter
- Cardiopulmonary resuscitation
- Emphysema
- Chronic obstructive pulmonary disease
- Asthma
Management
Shown below is an algorithm depicting the management of tension pneumothorax.
Characterize the symptoms:[1] ❑ Breathlessness | |||||||||||||||||||||||||||||||||||||
Examine the patient: Vital signs ❑ Respiratory rate:
❑ Heart rate: ❑ Blood pressure Focused chest examination[1] Inspection ❑ Reduced lung expansion on the affected side Palpation ❑ Trachea shifted to the opposite side Percussion Auscultation ❑ Diminished breath sounds on the affected side | |||||||||||||||||||||||||||||||||||||
First aid: ❑ Airway, breathing, and circulation | |||||||||||||||||||||||||||||||||||||
Categorize the Patient | |||||||||||||||||||||||||||||||||||||
Hemodynamically Stable | Hemodynamically Unstable | ||||||||||||||||||||||||||||||||||||
Confirm diagnosis Imaging studies
❑ Chest CT scanning | Emergency chest drain ❑ Aseptic preparation
❑ Use 14-16 G intravenous cannula | ||||||||||||||||||||||||||||||||||||
Do`s
- Serial chest radiographs every 6 hrs on the first day after injury to rule out pneumothorax is ideal.[2]
Dont`s
References
- ↑ 1.0 1.1 MacDuff A, Arnold A, Harvey J, BTS Pleural Disease Guideline Group (2010). "Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline 2010". Thorax. 65 Suppl 2: ii18–31. doi:10.1136/thx.2010.136986. PMID 20696690.
- ↑ 2.0 2.1 Sharma A, Jindal P (2008). "Principles of diagnosis and management of traumatic pneumothorax". J Emerg Trauma Shock. 1 (1): 34–41. doi:10.4103/0974-2700.41789. PMC 2700561. PMID 19561940.