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Tension pneumothorax: Dx and Rx

Classic signs include decreased breath sounds, distended neck veins, and non-midline trachea. These are VERY uncommon. More common changes suggestive of tension pneumothorax include hypotension, tachycardia, narrowing pulse pressure, and oxygen desaturation. Under anesthesia, these patients may exhibit a rise in airway pressures. Awake, they may become tachypnic.

In the setting of hemodynamic instability, treatment is immediate release of tension (14 ga. angiocatheter if possible, knife/chest tube if not). If the pneumothorax was caused by N2O or CO2, is not associated pulmonary trauma, and the patient is hemodynamically stable, consider waiting – spontaneous resolution of these pneumothoraces can occur in as few as 30 60. PEEP has also been used to treat a capnothorax from laparoscopy.

Tension Pneumothorax

  • Diagnosis: hypotension, tachycardia, narrow pulse pressure, hypoxemia, rise in airway pressures
  • Treatment: needle/knife for relief of tension (in certain cases may consider waiting)