Tension pneumothorax resident survival guide: Difference between revisions
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{{familytree | | | | | | | H01 | | | | | | | | | |H01=<div style="float: left; text-align: left; padding:1em;"> '''Insert chest drain'''<BR> | |||
❑ Requirments | |||
:❑ Written consent<BR> | |||
:❑ Clean area for the procedure<BR> | |||
:❑ Competent operator and nursing staff<BR> | |||
❑ Equipment required | |||
:❑ 1% [[lignocaine]] | |||
:❑ Alcohol based skin cleanser | |||
:❑ Sterile drapes, gown, gloves | |||
:❑ Needles, syringes, gauze swabs | |||
:❑ Scalpel, suture (0 or 1-0 silk) | |||
:❑ Chest tube kit | |||
:❑ Closed system drain (including water) and tubing | |||
:❑ Dressing | |||
:❑ Clamp | |||
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==Do`s== | ==Do`s== | ||
*Serial chest radiographs every 6 hrs on the first day after injury to rule out pneumothorax is ideal.<ref name="pmid19561940">{{cite journal| author=Sharma A, Jindal P| title=Principles of diagnosis and management of traumatic pneumothorax. | journal=J Emerg Trauma Shock | year= 2008 | volume= 1 | issue= 1 | pages= 34-41 | pmid=19561940 | doi=10.4103/0974-2700.41789 | pmc=PMC2700561 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19561940 }} </ref> | *Serial chest radiographs every 6 hrs on the first day after injury to rule out pneumothorax is ideal.<ref name="pmid19561940">{{cite journal| author=Sharma A, Jindal P| title=Principles of diagnosis and management of traumatic pneumothorax. | journal=J Emerg Trauma Shock | year= 2008 | volume= 1 | issue= 1 | pages= 34-41 | pmid=19561940 | doi=10.4103/0974-2700.41789 | pmc=PMC2700561 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19561940 }} </ref> | ||
*Leave the cannula in place until bubbling is confirmed in the chest drain underwater seal system | |||
==Dont`s== | ==Dont`s== |
Revision as of 03:32, 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
- 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
❑ Ultrasonography | Emergency needle decompression ❑ Aseptic preparation
❑ Use 14-16 G intravenous cannula
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Admit the patient | |||||||||||||||||||||||||||||||||||||
Insert chest drain ❑ Requirments
❑ Equipment required
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Do`s
- Serial chest radiographs every 6 hrs on the first day after injury to rule out pneumothorax is ideal.[2]
- Leave the cannula in place until bubbling is confirmed in the chest drain underwater seal system
Dont`s
References
- ↑ 1.0 1.1 1.2 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.