Tension Pneumothorax

About Tension Pneumothorax

Tension pneumothorax is a life-threatening emergency where air accumulates in the pleural space with each breath but cannot escape, creating a one-way valve effect. This leads to progressive lung collapse, mediastinal shift, and cardiovascular compromise requiring immediate decompression.

Pathophysiology

Air enters the pleural space through a chest wall defect or ruptured bleb that acts as a one-way valve, allowing air in during inspiration but preventing escape during expiration. Progressive air accumulation increases intrapleural pressure, causing complete lung collapse, mediastinal shift away from the affected side, and compression of the contralateral lung and great vessels, resulting in decreased venous return and cardiac output.

Clinical Reasoning

Diagnosis is primarily clinical, presenting with severe dyspnea, chest pain, tachycardia, hypotension, and absent breath sounds on the affected side with hyperresonance to percussion. The presence of tracheal deviation away from the affected side and jugular venous distension indicates advanced tension requiring immediate needle decompression followed by chest tube placement, as waiting for imaging can be fatal.