Tension Pneumothorax

What is it?​

• A special type of pneumothorax wherein air enters the pleural space and is unable to escape​
• As the air accumulates and is not released it impairs respiration and the hearts' ability to pump effectively, thus reducing cardiac output 

Causes?​

• Trauma (e.g. GSW, Stabbing)​

• Mechanical Ventilation (PPV)​

• Spontaneous (rare)

Signs/Symptoms

• History of:​
  • Shortness of breath​
  • Acute chest pain​
  • Shallow breathing​
• Clinical Findings:​
  • Tracheal deviation​
  • JVD​
  • Difficulty ventilating ​
  • Asymmetric chest rise/fall​
  • Decreased/absent breath sounds on affected side​
• This may be difficult to determine in a patient who is VSA. Consider this differential diagnosis if the history and clinical findings are readily apparent.

Why Leave Early

• In short – Decompression (thoracostomy) and definitive management!​
  • Decompression occurs as a channel (needle or chest tube) is inserted to relieve the accumulation of air in the intrapleural space ​

*ACPs have the ability to perform a needle thoracostomy.  Therefore, do not have to leave early if decompression is successful​

• If the cause of the arrest is not clear, treat per the Medical Cardiac Arrest Medical Directive​
• Of note, trauma is a common cause of Tension Pneumothorax, and where trauma is a suspected cause of arrest, very early transport is always indicated where Trauma TOR criteria is not met per the Traumatic Cardiac Arrest Medical Directive

In Summary

• Tension pneumothorax can occur when air enters the pleural space but cannot escape​
• Tension pneumothorax can lead to cardiac arrest due to obstructive shock​
• If highly suspected (history makes sense and clinical signs are present), consider very early transport ​
• This pathology can be treated via thoracostomy to relieve the pressure​
  • ACP can perform needle thoracostomy​
  • If ACP decompression unsuccessful or PCP crew, transport to hospital after minimum one analysis​

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