TENSION

PNEUMOTHORAX

Dr. Krishna Chaitanya Jinnuri

Consultant
Dept of Emergency Medicine
Medicover Hospitals,Nellore.
PNEUMO-THORAX :
Air in the pleural space
Hall mark : Collapsed Lung

Etiology :
1.SPONTANEOUS
a) Primary Spontaneous – No underlying lung disease ( young,tall,men)
b) Secondary Spontaneous – Have underlying lung disease (Obstructive, Destructive &
Cavitatory Lung diseases)

2. TRAUMATIC
a) Non-Iatrogenic
b) Iatrogenic
PNEUMO-THORAX :
ABCDEFGHI – mnemonic
Abscess,
Bacterial Pnemonia(necrotizing)
COPD/Cystic Fibrosis/Congenital Cysts/Collagen D/s – Marfan’s,RA,EDS,
Draining (thoracocentesis),
Esophageal rupture/Endometreosis(Catamenial Pneumothorax)/ Eosinophillic granuloma,
Fractured ribs,
Gunshot injuries,
HIV-P.Jiroveci
Iatrogenic

Q) While inserting a CVC , Patient develops resp.distress MCC ?

Signs & Symptoms :

• Symptoms :
Sudden onset chest pain(pleuritic)/tightness and Dyspnoa
Lie  Affected side

• Signs :
TYPES :

• CLOSED PNEUMO : The entry point will be spontaneously closed. No further communication.
Intra pleural pressure < atmospheric. Sub-atmospheric

• OPEN PNEUMO : The entry point will remain opened throughout inspiration and expiration.
Two way opening.
Intra pleural pressure = atmospheric pressure.
• TESNION PNEUMOTHORAX : Entry point will be Valve like. ONE WAY-VALVE effect. During
inspiration air enters pleural cavity, during expiration air unable to exit from
pleural cavity. with each breath more and more air is added.
Complications

• Hypoxia : Due to mechanical compression of lungs

• Impaired cardiac filling : due to mechanical compression of heart

• Impaired venous return : due to Increased intrathoracic pressure

Physical Diagnosis : ABC assesment

LISTEN  Usually breath sounds are absent
LOOK  Respiratory distress, may have external injury
COUNT  Tachypnea
MONITOR  Hypoxia
PALPATE  Tracheal deviation, Unilateral Hyperresonace
Radiological Diagnosis ?

• When ultrasound is available, tension pneumothorax can be diagnosed using an extended FAST
(eFAST): seashore, bar code, or stratosphere sign in M mode.

• Xray: Increased Lucency,Absence of Bronchovascular markings, Mediastinal deviation to Opp side.

• The pleural line may be difficult to detect with a small penmothorax unless high-quality PA and
Lateral view chest films are obtained and viewed under bright light. A skin fold may mimic the
pleural line. Usually the patient is asymptomatic in simple pnemothorax

• The most common radiographic manifestations of tension pneumothorax are mediastinal shift,

diaphragmatic depression, and rib cage expansion.

• CT is the Gold Standard for the diagnosis of Pneumothorax.

• USG Lung:
• X-Rays
• CT scan
•  
TREATMENT FOR PNEUMOTHORAX

•  Small Primary Pneumo : Spontaneous resolution, High Conc O2 supplement for faster absorption

• Large Pneumo+ Dysopnea : Needle Decompression F/by ICD

• Recurrent Pneumo : Pleurodesis

• More complicated + Recurrent + Failed ICD  Limited Pleurectomy

TREATMENT FOR TENSION-PNEMOTHORAX ?

•  NEEDLE DECOMPRESSION
NEEDLE DECOMPRESSION- PROCEDURE

• a 14-16 gauge Catheter

• 5th ICS slightly anterior to the mid-axillary line for adult
• UNCHANGED 2nd ICS for child
• 28-32 Fr tube for chest drain
•  
 TENSION PNEMOTHORAX SIMPLE PNEMOTHORAX

HYPOXIA Often severe Minimal or absent

SHOCK Always some hemodynamic compromise May be Tachycardia, Never Hypotension

BREATH SOUNDS Absent on affected side May be normal or reduced

Temporize Temporize with Needle decompression No temporizing measures needed

Rx Definitive Rx with Chest tube Rx with O2, Pleural drain, or Chest tube
THANK YOU