what is the treatment for tension pneumothorax emt

Tension pneumothorax

is a medical emergency that requires treatment with needle decompression of the chest, also known as needle thoracostomy, to allow the relief of the trapped air from the pleural space.

Full Answer

What are the signs and symptoms of tension pneumothorax?

What are the signs and symptoms of a tension Pneumothorax? (TTRAPPED) Tachycardia Tracheal deviation Respiratory distress Acute hypotension Pleuritic Chest pain Presence of absent breath sounds unilateraly Elevated cough Distention of neck veins.

What causes a tension pneumothorax?

What Causes A Tension Pneumothorax?

• Penetrating Injury To The Chest. Most common cause of tension pneumothorax is penetrating injury (trauma) to the chest. ...
• Closed Pneumothorax. ...
• Spontaneous Pneumothorax. ...
• Iatrogenic Lung Injuries. ...
• Positive pressure ventilation. ...

Which medications are used in the treatment of pneumothorax?

Treatment

• Observation. If only a small portion of your lung is collapsed, your doctor may simply monitor your condition with a series of chest X-rays until the excess air is completely ...
• Needle aspiration or chest tube insertion. ...
• Nonsurgical repair. ...
• Surgery. ...
• Ongoing care. ...

When are all signs point to tension pneumothorax?

This happens because air enters the pleural cavity and is trapped there during expiration ( breathing out). Pressure builds up and compresses the organs of the chest including the lung and heart. Symptoms and signs include chest pain that has a sudden or sharp onset, shortness of breath, rapid breathing, and rapid heart rate.

What is the best treatment for tension pneumothorax?

Treatment of tension pneumothorax is immediate needle decompression by inserting a large-bore (eg, 14- or 16-gauge) needle into the 2nd intercostal space in the midclavicular line. Air will usually gush out.

What is the most common treatment for a pneumothorax?

Treatment for a pneumothorax usually involves inserting a needle or chest tube between the ribs to remove the excess air. However, a small pneumothorax may heal on its own.

What are the treatment options for pneumothorax?

Treatment options may include observation, needle aspiration, chest tube insertion, nonsurgical repair or surgery. You may receive supplemental oxygen therapy to speed air reabsorption and lung expansion.

What is a tension pneumothorax?

A tension pneumothorax is a severe condition that results when air is trapped in the pleural space under positive pressure, displacing mediastinal structures, and compromising cardiopulmonary function. Early recognition of this condition is life-saving both outside the hospital and in modern ICU.

What is the clinical presentation of a tension pneumothorax?

Tension pneumothorax is classically characterized by hypotension and hypoxia. On examination, breath sounds are absent on the affected hemothorax and the trachea deviates away from the affected side. The thorax may also be hyperresonant; jugular venous distention and tachycardia may be present.

What is the first line treatment for pneumothorax?

Contou et al recommended that clinicians consider drainage via a small-bore catheter as a first-line treatment for pneumothorax of any cause.

Why does oxygen help pneumothorax?

It is generally accepted that oxygen therapy increases the resolution rate of pneumothorax (1,2). The theoretical basis is that oxygen therapy reduces the partial pressure of nitrogen in the alveolus compared with the pleural cavity, and a diffusion gradient for nitrogen accelerates resolution (3,10).

Is tension pneumothorax primary or secondary?

Pneumothorax is divided to primary and secondary. A primary pneumothorax is considered the one that occurs without an apparent cause and in the absence of significant lung disease. On the other hand secondary pneumothorax occurs in the presence of existing lung pathology.

What is tension pneumothorax?

Tension pneumothorax symptoms. A tension pneumothorax occurs when the patient cannot compensate, and several events begin to occur that can lead to death. As air fills the pleural space on inspiration through the opening with an open pneumothorax, the wound can act as a one-way valve and not allow the air to exit.

What is a pneumothorax?

A pneumothorax means air in the chest cavity. This occurs when air, either from the lungs or outside the body, enters the pleural space that is normally occupied by the lung. It is called a closed pneumothorax when the chest wall is intact. With an intact chest wall, a pneumothorax can be caused by several things, but the most frequently encountered cause is from trauma resulting in a rib fracture that punctures a lung, releasing air into the pleural space. The signs and symptoms for a closed pneumothorax are: 1 Chest pain 2 Tachypnea 3 Dyspnea

What is the condition where air is trapped in the pleural cavity?

Tension pneumothorax is a life-threatening condition that can occur with chest trauma when air is trapped in the pleural cavity leading to a cascading impact including a rapid deterioration of a patient's ability to maintain oxygenation. Tension pneumothorax is more likely to occur with trauma involving an opening in the chest wall.

How to perform needle decompression?

When inserting the needle, it should be inserted at a 90-degree angle to the chest wall.

What causes a closed pneumothorax?

With an intact chest wall, a pneumothorax can be caused by several things, but the most frequently encountered cause is from trauma resulting in a rib fracture that punctures a lung, releasing air into the pleural space. The signs and symptoms for a closed pneumothorax are: Chest pain. Tachypnea. Dyspnea.

Is a closed pneumothorax life threatening?

Dyspnea. Normally, a closed pneumothorax is not a life-threatening condition unless it progresses into a tension pneumothorax. An open pneumothorax occurs when there is an opening in the chest wall, which can be the result of penetrating trauma such as a gunshot wound or stabbing.

Is there a high probability of a tension pneumothorax?

The medical provider needs to be keenly aware that there is a high probability of a tension pneumothorax if the patient has an open trauma to the chest wall. Good assessment skills, proper equipment, and the training to effectively relieve a tension pneumothorax are vital to save patients from this critical condition.

What is the goal of pneumothorax?

The goal in treating a pneumothorax is to relieve the pressure on your lung, allowing it to re-expand. Depending on the cause of the pneumothorax, a second goal may be to prevent recurrences. The methods for achieving these goals depend on the severity of the lung collapse and sometimes on your overall health.

How to diagnose pneumothorax?

Diagnosis. A pneumothorax is generally diagnosed using a chest X-ray. In some cases, a computerized tomography (CT) scan may be needed to provide more-detailed images. Ultrasound imaging also may be used to identify a pneumothorax.

What activities can you not do after pneumothorax surgery?

You may need to avoid certain activities that put extra pressure on your lungs for a time after your pneumothorax heals. Examples include flying, scuba diving or playing a wind instrument. Talk to your doctor about the type and length of your activity restrictions.

How does blood work to heal a lung leak?

The blood creates a fibrinous patch on the lung (autologous blood patch), sealing the air leak. Passing a thin tube (bronchoscope) down your throat and into your lungs to look at your lungs and air passages and placing a one-way valve. The valve allows the lung to re-expand and the air leak to heal.

What is a flexible chest tube?

A flexible chest tube is inserted into the air-filled space and may be attached to a one-way valve device that continuously removes air from the chest cavity until your lung is re-expanded and healed.

What is the procedure to remove air from a collapsed lung?

Needle aspiration or chest tube insertion. If a larger area of your lung has collapsed, it's likely that a needle or chest tube will be used to remove the excess air. Needle aspiration. A hollow needle with a small flexible tube (catheter) is inserted between the ribs into the air-filled space that's pressing on the collapsed lung.

How long does it take for a lung to collapse?

This may take several weeks.

What is tension pneumothorax?

Tension pneumothorax is a medical emergency that requires treatment with needle decompression of the chest, also known as needle thoracostomy, to allow the relief of the trapped air from the pleural space. During needle decompression, an emergency technician or trained physician will insert a large needle through the chest wall, ...

What are the symptoms of pneumothorax tension?

Additional signs can include tracheal deviation away from the pneumothorax, distended neck veins, and decreased or absent breath sounds upon auscultation.

What happens when air accumulates in the pleural space?

The accumulated air in the pleural space puts positive pressure on the lung and prevents it from expanding properly, which causes respiratory distress. As the air continues to accumulate, the trachea and other structures of the chest can be pushed away from the pneumothorax, leading to increased difficulty breathing.

What happens after a chest tube is placed?

After placing the chest tube, a chest X-ray is usually obtained to check the location of the tube and the successful re-expansion of the lung.

Can a tension pneumothorax be transferred to a critical care unit?

This procedure can be life-saving, especially in the prehospital setting, as transport to the hospital can delay treatment. Individuals with a tension pneumothorax should be transferred to a critical care unit, where they can be monitored for their vital signs and administered high-concentration supplemental oxygen.

Can tension pneumothorax be treated with chest X-ray?

A strong clinical suspicion of tension pneumothorax is enough to initiate emergency treatment, which should not be delayed by any imaging studies. Once the individual has been successfully treated, a chest X-ray can be performed.

Can pneumothorax be caused by mechanical ventilation?

For people receiving mechanical ventilation, high positive pressure during the inspiratory phase can force air from the lungs into the pleural space, causing a rapidly growing pneumothorax. Rarely, a spontaneous tension pneumothorax can occur in the absence of any precipitating factors.

How many patients did not get a pneumothorax after needle thoracostomy?

They used ultrasound and CT scans, seeking to confirm the presence of a pneumothorax. Fifteen patients in their sample (26%) had no pneumothorax, which means these patients received unnecessary needle thoracostomy and did not get a pneumothorax after needle thoracostomy.

Is needle thoracostomy rare?

Field experience with needle thoracostomy during a presumed tension pneumothorax is rare, and in the prehospital setting, it ’s difficult to determine whether one exists. “Typical” signs may be masked, lung sounds are difficult to hear in noisy environments and jugular venous distention may be absent due to hypotension (or hidden by C-collars).

Which organs are involved in pneumothorax?

Due to their proximity to the ribs, most common organs involved are the lungs, liver, and spleen. Puncture of the lungs can lead to pneumothorax which will compromise breathing and/or tension pneumothorax which can compromise both breathing and circulation.

How does an air pocket prevent lung expansion?

If this air pocket expands far enough it can prevent lung expansion by replacing the space the lung occupies in the chest with air. In extreme cases, each of the patient's breaths will draw more air into the chest, raising the pressure within the chest, resulting in a tension pneumothorax.

What are the key closed chest injuries?

The key closed chest injuries are secondary puncture injury, flail chest, sternal fracture, and commotio cordis. SECONDARY PUNCTURE INJURY: Fragments or sharp ends of fractured ribs can lead to the puncture and bleeding of organs within the chest and abdomen. Due to their proximity to the ribs, most common organs involved are the lungs, liver, ...

What is positive pressure ventilation?

Positive pressure ventilation is the definitive treatment as it removes the need for a rigid chest wall to draw air into the lungs. If positive pressure ventilation is unavailable or the patient cannot cooperate with ventilations given by bag-valve-mask, 100% oxygen may temporarily stabilize patients.

What happens if you have a paradoxical movement of your chest?

Paradoxical movement of the chest results in significantly reduced ventilation, this leads to the symptoms of shortness of breath, difficulty breathing, and extreme pain. If untreated with positive pressure oxygen and rapid surgery this will lead to low oxygen saturation and potential organ damage resulting from hypoxia.

Can chest trauma be fatal?

Chest trauma can result in several injuries that may be fatal to a patient if they are not stabilized prior to transport. These injuries can be roughly divided into open and closed chest injuries, based on whether or not the chest cavity is exposed to the surrounding atmosphere. This section will discuss how these injuries relate to ...

Can a splenic puncture cause internal bleeding?

Liver and Splenic puncture can lead to massive internal bleeding due to the extreme amount of blood that normally flows through these organs every minute. For all forms of internal injury secondary to a rib fracture, surgery is necessary, making transport to a trauma center an urgent necessity.

What valve should be used after needle thoracostomy?

If available, a Heimlich valve may be used.

Can paramedics decompress needles?

Most paramedics are trained and protocolized to perform needle decompression for immediate relief of a tension pneumothorax. However, if an incorrect diagnosis of tension pneumothorax is made in the prehospital setting, the patient's life may be endangered by unnecessary invasive procedures.

Is tension pneumothorax a clinical diagnosis?

Tension pneumothorax is a clinical diagnosis requiring emergent needle decompression, and therapy should never be delayed for x-ray confirmation. Radiograph of a new left-sided pneumothorax in a patient on mechanical ventilation, requiring high inflation pressures.