TENSION

PNEUMOTH
ORAX
Presented by:
INTRODUCTION TO TENSION
PNEUMOTHORAX
 Tension pneumothorax is the abnormal collection of air in the pleural space i.e. the
space between chest wall and lungs (Weiser, 2018).
 This is a life threatening condition in which a one way valve is created in the
damaged tissue which allows the air to trap in the pleural space.
 This air keeps on putting pressure on the affected area during expiration (breathing
out)
 This pressure further leads to the compression of chest organs including heart and
lungs.
 It could further lead to collapsed lungs or cardiorespiratory arrest
 Prompt diagnosis and treatment are required to avoid such consequences.
INTRODUCTION TO TENSION
PNEUMOTHORAX
Pneumothorax General Overview
 Pneumothorax is a condition of collapsed lungs
 It is caused when the air gets trapped in the pleural area
 It can be of three types;
1. Open Pneumothorax
2. Close Pneumothorax
3. Tension Pneumothorax
INTRODUCTION TO TENSION
PNEUMOTHORAX
INTRODUCTION TO TENSION
PNEUMOTHORAX
 Closed Pneumothorax: This is the trapping of air in the pleural space in a
way that the chest wall remains intact. It generally happens when the lungs
get punctured due to trauma or sudden shock and the air starts to enter the
pleural area.
 Open Pneumothorax: Open pneumothorax occurs when the air start to enter
pleural space via a wound opening such as stabbing or gunshot. The chest
wall also does not remain intact under this condition.
 Tension Pneumothorax: Tension pneumothorax is simply the extension of
open Pneumothorax when the patient is not compensated leading to many life
threatening events. Notice that wound or trauma is not the only reason that
can cause this condition.
TENSION PNEUMOTHORAX
PATHOPHYSIOLOGY
Due to disrupted parietal pleura, visceral pleura or tracheobronchial
tree, the air start to enter into the pleural space but unable to exit.
This progressive accumulation of air start to build pressure in chest.
It further causes ipsilateral lung to collapse and puts a compression
on superior vena cava, heart, trachea, lung, and contralateral lung.
Additionally, it causes impairment to the respiratory function and
reduction of venous return to heart leading to reduce cardiac output
resulting in hemodynamic instability and hypoxia(amboss, 2020).
TENSION PNEUMOTHORAX –
CAUSES
Primary
Causes
spontaneous

Traumatic Secondary
spontaneous
TENSION PNEUMOTHORAX –
CAUSES
Primary Spontaneous Causes
 This type of pneumothorax occurs in the absence of known lung disease and the patient
doesn’t have a history of any such disease.
 The risk group exposed to primary spontaneous tension pneumothorax include the following:
 Smokers of cannabis or tobacco
 Male sex is more exposed
 People having a family history of Pneumothorax
 People under age group of 15-34.
 Among the above factors, tobacco is the most common cause of this condition
TENSION PNEUMOTHORAX –
CAUSES
Secondary Spontaneous Causes
 These causes include a number of lung disorders and lung diseases such as;
chronic obstructive pulmonary disease (COPD, responsible for 70% of
causes).
cystic fibrosis
 acute severe asthma
necrotizing pneumonia
Tuberculosis
TENSION PNEUMOTHORAX –
CAUSES
Secondary Spontaneous Causes
Pneumocystis pneumonia (PCP)
lymphangioleiomyomatosis (LAM)
histiocytosis X
Sarcoidosis
Idiopathic pulmonary fibrosis
Lung cancer
Sarcomas,
Certain connective tissue disorders(medicalnewstoday, 2020).
TENSION PNEUMOTHORAX –
CAUSES
Traumatic causes
 Pneumothorax occurs because of trauma or impact.
 Penetrative injury is also a cause
 Injury that involves pressure on ribs or ribs fracture
 People exposed to blast may also have this condition even without any
apparent wound.
 Other causes include wounds resulting from stabs, gunshot, car accidents or
sports wounds.
TENSION PNEUMOTHORAX –
SIGNS/SYMPTOMS
 The initial signs and symptoms of tension pneumothorax are similar to the
signs of simple pneumothorax (which sometimes turns into a tension
pneumothorax).The symptoms include:
Breathlessness
Chest pain
Decreased blood-oxygen level
Blue-coloured lips and skin
Increased carbon dioxide level in the blood
TENSION PNEUMOTHORAX –
SIGNS/SYMPTOMS
Comas
Hypotension
neck vein distention
tracheal deviation
Poor compressibility to palpation
TENSION PNEUMOTHORAX –
TREATMENT
Needle Decompression
 Since tension pneumothorax is a type of medical emergency, immediate
treatment in the form of needle decompression is required (Aho et al., 2016).
 It is a life saving process that must be done immediately after diagnoses and in
case tube thoracostomy cannot be done quickly at the moment
 Under needle decompression, a large needle is inserted in the second
intercostal space into the midclavicular line.
 This process will cause the trapped air to gust out
 A large-bore needle is used with a 16 or 14 gauge
TENSION PNEUMOTHORAX –
TREATMENT
 Needle Decompression
 The needle can be of 5-8 cm. Using an 8cm needle is more effective but the
risk of damage to the inner structures increases with it.
 After the needle compression is done, the tension pneumothorax is converted
into a simple pneumothorax(Bickle & Gaillard, 2020).
 This condition must be further treated with the help of tube thoracostomy
 Additionally, chest x-rays must also be done to find whether the lungs have
properly expended and the chest tube has a proper placement or not.
TENSION PNEUMOTHORAX –
TREATMENT
Treatment Complications
 Diaphragmatic or Pulmonary laceration
 Perforation of other abdominal and chest structures
 Infection
 Bleeding
 If needle decompression is done after the false identification of tension
pneumothorax, it can cause pneumothorax
 Intercostal neuralgia which occurs because the neurovascular bundle present
below the rib may get injured
REFERENCES

 Aho J.M., Thiels C.A., E.l., & Khatib M.M, et al. (2016). Needle thoracostomy: Clinical effectiveness
is improved using a longer angiocatheter. J Trauma Acute Care Surg, 80(2), 272–277.
 amboss. (2020). Pneumothorax. Retrieved May 3, 2020, from amboss:
https://www.amboss.com/us/knowledge/Pneumothorax
 Bickle, I., & Gaillard, F. (2020). Tension pneumothorax. Retrieved May 2, 2020, from radiopaedia:
https://radiopaedia.org/articles/tension-pneumothorax
 medicalnewstoday. (2020). What to know about pneumothorax. Retrieved May 2, 2020, from
medicalnewstoday: https://www.medicalnewstoday.com/articles/318110
 Weiser, T.G. (2018, November). Pneumothorax (Tension). Retrieved May 2, 2020, from msdmanuals:
https://www.msdmanuals.com/professional/injuries-poisoning/thoracic-trauma/pneumothorax-tension