Tension Pneumothorax

Tension pneumothorax is progressive intrapleural air accumulation that impairs ventilation and venous return, potentially causing rapid cardiopulmonary collapse.ScienceDirect+1ScienceDirectPrehospital decompression of tension pneumothorax: Have we moved the needle?PubMedTension Pneumothorax - StatPearls - NCBI Bookshelf In trauma, ICU, and prehospital populations, reported incidence is approximately 1% to 3%, although the true frequency is uncertain.Wolters Kluwer+1Wolters KluwerClinical Presentation of Patients With Tension... : Annals of SurgeryScienceDirectPrehospital decompression of tension pneumothorax: Have we moved the needle?

Suspect the diagnosis in a compatible setting—thoracic trauma, positive-pressure ventilation, or iatrogenic pleural injury—with acute respiratory or circulatory deterioration. Hemodynamic instability or severe respiratory compromise should trigger immediate decompression before imaging.PubMed+1PubMedPrehospital management of chest injuries in severely injured patients—a systematic review and clinical practice guideline update - PMCnice org ukRecommendations | Major trauma: assessment and initial management | Guidance | NICE Waiting for chest radiography in mechanically ventilated patients with suspected tension pneumothorax has been associated with increased risk of death; major authorities therefore support emergency thoracostomy when suspicion is high.PubMedPubMedClinical manifestations of tension pneumothorax: protocol for a systematic review and meta-analysis

In an unstable patient with suspected tension pneumothorax, diagnosis is clinical and decompression takes priority over chest radiography or CT.PubMed+2PubMedClinical manifestations of tension pneumothorax: protocol for a systematic review and meta-analysisPubMedTension Pneumothorax - StatPearls - NCBI Bookshelfnice org ukRecommendations | Major trauma: assessment and initial management | Guidance | NICE CT is the most definitive imaging modality for pneumothorax when radiography is uncertain, but routine CT is inappropriate for suspected tension physiology.PubMedPubMedTension Pneumothorax - StatPearls - NCBI Bookshelf

When the patient is sufficiently stable for testing, chest radiography and point-of-care ultrasound can support the diagnosis. eFAST may augment clinical assessment only when skilled operators and equipment are immediately available and use will not delay transfer or treatment; a negative chest eFAST does not exclude pneumothorax.nice org uknice org ukRecommendations | Major trauma: assessment and initial management | Guidance | NICE

Absent lung sliding is not specific for pneumothorax: mimics include COPD blebs, consolidation, atelectasis, mainstem intubation, scarring, and interstitial lung disease. In the appropriate setting, absent lung sliding together with a dilated inferior vena cava or mediastinal shift should heighten concern for tension physiology.ScienceDirectScienceDirectUltrasound Findings in Tension Pneumothorax: A Case Report

Emergency decompression may be performed with needle decompression, simple/open thoracostomy, or tube thoracostomy. Comparative studies have not established superiority among these approaches.PubMedPubMedPrehospital management of chest injuries in severely injured patients—a systematic review and clinical practice guideline update - PMC NICE recommends open thoracostomy rather than needle decompression when expertise is available in the prehospital setting, and in hospital recommends open thoracostomy followed by chest drain placement for tension pneumothorax.nice org uknice org ukRecommendations | Major trauma: assessment and initial management | Guidance | NICE StatPearls similarly describes immediate needle decompression followed by tube thoracostomy as standard emergency management.PubMedPubMedTension Pneumothorax - StatPearls - NCBI Bookshelf

Needle decompression should be understood as a bridge, not definitive treatment. Catheter obstruction, kinking, dislodgement, insufficient intrapleural reach, or ongoing air leak can leave or recreate tension physiology; proceed to tube thoracostomy after initial release and reassess continuously.PubMed+2PubMedTension Pneumothorax - StatPearls - NCBI Bookshelfnice org ukRecommendations | Major trauma: assessment and initial management | Guidance | NICEScienceDirectTension Pneumothorax Managed Without Immediate ...

Anatomic and device selection remain debated. In one ultrasound pilot study, 28 of 30 healthy volunteers had a smaller skin-to-pleura distance at the fifth intercostal space along the midaxillary line than at the second intercostal space midclavicular line.ScienceDirectScienceDirectUsing Ultrasound to Determine Optimal Location for Needle Decompression of Tension Pneumothorax: A Pilot Study - ScienceDirect CT-based analyses cited in that study estimated lower anticipated failure at the fifth intercostal space midaxillary line than the second intercostal space midclavicular line, but available evidence is heterogeneous and primarily based on anatomic measurements rather than clinical outcomes.ScienceDirect+2ScienceDirectUsing Ultrasound to Determine Optimal Location for Needle Decompression of Tension Pneumothorax: A Pilot Study - ScienceDirectScienceDirectPrehospital decompression of tension pneumothorax: Have we moved the needle?PubMedMeta-analysis of the optimal needle length and decompression site for tension pneumothorax and consensus recommendations on current ATLS and ETC guidelines

Following any decompression, reassess oxygenation, ventilation, blood pressure, chest findings, and overall trajectory immediately. NICE specifically recommends observation for recurrent tension pneumothorax after chest decompression.nice org uknice org ukRecommendations | Major trauma: assessment and initial management | Guidance | NICE Persistent deterioration after a needle attempt should be treated as possible unsuccessful decompression, ongoing leak, malposition, or an alternative/additional cause of shock or hypoxemia; establish definitive drainage without delay when tension physiology persists.PubMed+1PubMedTension Pneumothorax - StatPearls - NCBI BookshelfScienceDirectTension Pneumothorax Managed Without Immediate ...

Tube thoracostomy and the underlying injury can produce complications, including pulmonary injury and recurrent tension physiology. Ongoing monitoring after stabilization is therefore necessary.PubMedPubMedTension Pneumothorax - StatPearls - NCBI Bookshelf