Illustration depicting multiple fractures of the left upper chest wall. Efficacy of follow-up evaluation in penetrating thoracic injuries: 3- vs. 6-hour radiographs of the chest. [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. With time severe dyspnea, tachycardia and hypotension occur. 2010 Aug. 65 Suppl 2:ii18-31. 2000 Oct. 26 (10):1434-40. Paydar S, Ghahramani Z, Ghoddusi Johari H, Khezri S, Ziaeian B, Ghayyoumi MA, Fallahi MJ, Niakan MH, Sabetian G, Abbasi HR, Bolandparvaz S. Tube Thoracostomy (Chest Tube) Removal in Traumatic Patients: What Do We Know? These additional signs indicate hyperexpansion of the hemithorax: In the rare instance of bilateral tension pneumothoraces, there may be no cardiomediastinal shift 6,7. Dominguez KM, Ekeh AP, Tchorz KM, Woods RJ, Walusimbi MS, Saxe JM, McCarthy MC. ), which permits others to distribute the work, provided that the article is not altered or used commercially. 129 (5):1274-81. Shostak E, Brylka D, Krepp J, Pua B, Sanders A. [QxMD MEDLINE Link]. Endoscopy. Reference article, Radiopaedia.org (Accessed on 01 May 2023) https://doi.org/10.53347/rID-15362, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":15362,"questionManager":null,"mcqUrl":"https://radiopaedia.org/articles/tension-pneumothorax/questions/870?lang=us"}, View Frank Gaillard's current disclosures, see full revision history and disclosures, dilation (>2.1 cm) and absence of variation with respiration imply a pathologically elevated CVP, consistent with obstructive, hyperdynamic right heart with underfilling, the right ventricular diameter will be reduced as a result of the reduction in filling/preload. Medication may be necessary to treat a pulmonary disorder that causes the pneumothorax. Is Lung Damage More Extensive in Marijuana or Cigarette Smokers? Other tension pneumothorax Chest Discomfort Chest Tightness Cough Cyanosis (Bluish Tinge to Skin) [QxMD MEDLINE Link]. Computed tomography scan demonstrating emphysematouslike changes (ELCs) in a patient with chronic obstructive pulmonary disease (COPD). Patients may demonstrate shallower breaths as they attempt to avoid deep breathing that triggers pain. Tension pneumothorax occurs when the air enters the pleural space but cannot fully exit, similar to a one-way valve mechanism through the disrupted pleura or tracheobronchial tree. Pneumothorax in cystic fibrosis. In this situation, the ipsilateral lung will, if normal, collapse completely (although a less than normally compliant lung may remain partially inflated). This can occur within minutes. (2010) Emergency medicine clinics of North America. Radiograph of an older man who was admitted to the intensive care unit (ICU) postoperatively. The increased intrathoracic pressure with inspiration worsens the hypotension. Chest. Mary C Mancini, MD, PhD, MMM 21. 2006 Mar. Iatrogenic pneumothorax is a traumatic pneumothorax that results from injury to the pleura, with air introduced into the pleural cavity secondary to a diagnostic or therapeutic medical intervention. Abdominal distention may occur from increased pressure in the thoracic cavity producing caudal deviation of the diaphragm and from secondary pneumoperitoneum produced as air dissects across the diaphragm through the pores of Kohn. Increased pulmonary artery pressures and decreased cardiac output or cardiac index are evidence of tension pneumothorax in patients with Swan-Ganz catheters. [1][2]It is a severe condition that results when air is trapped in the pleural space under positive pressure, displacing mediastinal structures and compromising cardiopulmonary function. 3 (1): 1. Computed tomography scan demonstrating blebs in a patient with chronic obstructive pulmonary disease (COPD). Awareness of site for needle thoracocentesis. Chen KC, Chen PH, Chen JS. Baumann MH, Strange C. Treatment of spontaneous pneumothorax: a more aggressive approach?. Simple aspiration versus chest-tube insertion in the management of primary spontaneous pneumothorax: a systematic review. A tension pneumothorax develops when a 'one-way valve 'is created and air leak occurs either from the lung or through the chest wall. British Thoracic Society guidelines on respiratory aspects of fitness for diving. Hypotension worsens with inspiration due to increased intrathoracic pressure. Radiograph depicting right main stem intubation that resulted in left-sided tension pneumothorax, right mediastinal shift, deep sulcus sign, and subpulmonic pneumothorax. Small-bore catheter versus chest tube drainage for pneumothorax. Vinson DR, Ballard DW, Hance LG, Stevenson MD, Clague VA, Rauchwerger AS, Reed ME, Mark DG., Kaiser Permanente CREST Network Investigators. In hypovolemic trauma patients with ongoing hemorrhage, the physical findings may lag behind the presentation of shock and cardiopulmonary collapse. In a small pneumothorax, many patients may present without symptoms. ( In a recent study, 95% of pneumothorax episodes were observed to be iatrogenic; of these, barotrauma secondary to mechanical ventilation resulted in 69.6% of cases, 41.1% of which were tension pneumothoraces. (2009) ISBN:0781779820. 125 (6):2345-51. Thorax. [Full Text]. The breach acts as a one-way valve. Zehtabchi S, Rios CL. Anesth Analg. (2005) Emergency medicine journal : EMJ. 2006 Mar. McPherson JJ, Feigin DS, Bellamy RF. Chest. ISBN:110702191X. Patients may or may not have symptoms, as this is typically a well-tolerated disease, although mortality in cases of esophageal rupture is very high. Arch Surg. Significant pneumothorax can cause mediastinal shift leading to impaired venous return and hemodynamic compromise. Nevertheless, tension pneumothorax should always be a consideration when acute compromise occurs. Common findings include chest tenderness, ecchymoses, and respiratory distress; hypotension or shock may be present. Greenberg's text-atlas of emergency medicine. Can J Surg. Whale C, Hallam C. Tension pneumothorax related to acupuncture. Tension pneumothorax can result in rapid development of severe symptoms associated with tracheal deviation away from the pneumothorax, tachycardia, and hypotension. Huang TW, Lee SC, Cheng YL, Tzao C, Hsu HH, Chang H, et al. Tension pneumothorax is a potentially life-threatening condition that medical professionals must treat as a medical emergency. Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline 2010. Mil Med. [Full Text]. 2008 Feb. 76 (2):198-206. [QxMD MEDLINE Link]. 2004 Jun. 47 (5):415-8. Initial assessment to determine whether the patient is stable or unstable dictates further evaluation. In a retrospective review of cases presenting to an academic medical center, 67% of identified patients had chest pain; 42% had persistent cough; 25% had sore throat; and 8% had dysphagia, shortness of breath, or nausea/vomiting. Chen JS, Hsu HH, Huang PM, Kuo SW, Lin MW, Chang CC, et al. [QxMD MEDLINE Link]. : Cardiac arrest ultra-sound exam--a better approach to managing patients in primary non-arrhythmogenic cardiac arrest. Tension pneumothorax has been reported during surgery with both single- and double-lumen tubes. Symptoms include chest pain, shortness of breath, rapid breathing, and a racing heart, followed by shock. Scuba divers and pilots must be advised not to dive or fly until the complete resolution of the pneumothorax by pleurodesis or thoracotomy. Shortness of breath/dyspnea in PSP is generally of sudden onset and tends to be more severe with SSPs because of decreased lung reserve. Feldman AL, Sullivan JT, Passero MA, Lewis DC. 1989 Dec. 96 (6):1302-6. Moore FO, Goslar PW, Coimbra R, Velmahos G, Brown CV, Coopwood TB Jr, et al. British Thoracic Society guidelines on respiratory aspects of fitness for diving. Tension pneumothorax during general anaesthesia is a rare but possibly deleterious event, especially where predisposing factors are absent or unknown, making diagnosis even challenging. Computed tomography scan in a patient with a history of bilateral pleurodesis and a strong family history of spontaneous pneumothorax. McPherson JJ, Feigin DS, Bellamy RF. Metersky ML, Colt HG, Olson LK, Shanks TG. [QxMD MEDLINE Link]. 22 (1): 8-16. Contralateral recurrence of primary spontaneous pneumothorax. On lung auscultation, decreased or absent breath sounds on the ipsilateral side, reduced tactile fremitus, hyper-resonant percussion sounds, and possible asymmetrical lung expansion are suggestive of pneumothorax. If patients become hemodynamically unstable or have a cardiac arrest, there is a high suspicion of tension pneumothorax. Chest. Pneumothoraces are classified as simple (no shift of mediastinal structures), tension (shift in mediastinal structures present), or open (air passing through an open chest wound). [QxMD MEDLINE Link]. If the patient is hemodynamically unstable and in acute respiratory failure, a bedside ultrasound should be performed to confirm the diagnosis if it is available for immediate use. Michael G Benninghoff, DO, MS is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Osteopathic Association, American Thoracic Society, Society of Critical Care MedicineDisclosure: Nothing to disclose. 2011 May. Duringinspiration, a sizeable high-pressure air collection accumulates in the intrapleural space and is not able to completely exit during expiration. [QxMD MEDLINE Link]. Lichtenstein D, Mezire G, Biderman P, Gepner A. 94 (3):512-3; table of contents. [QxMD MEDLINE Link]. 2002 Mar. Toffel M, Pin M, Ludwig C. [Thoracic Surgical Aspects of Seriously Injured Patients]. CXR can demonstrate one or more of the following: A chest computed tomography can be done if the diagnosis is unclear on the X-ray. 2004 Jun. Current aspects of spontaneous pneumothorax. Check the full list of possible causes and conditions now! [QxMD MEDLINE Link]. Shostak E, Brylka D, Krepp J, Pua B, Sanders A. [QxMD MEDLINE Link]. Contributed by Scott Dulebohn, MD, Tension pneumothorax. Options for Restoring Air-Free Pleural Space, American Association for the Surgery of Trauma, Eastern Association for the Surgery of Trauma, International Society for Magnetic Resonance in Medicine, American Association for Thoracic Surgery, American Association for the History of Medicine, American College of Osteopathic Emergency Physicians, Society for Surgery of the Alimentary Tract, Council of Emergency Medicine Residency Directors, American Society for Artificial Internal Organs. Eventually, impaired venous return results in cardiac arrest and . Radiograph showing subcutaneous emphysema and pneumothorax. Zhao DY, Zhang GL. [QxMD MEDLINE Link]. Ann Emerg Med. Tension pneumothorax is a clinical diagnosis requiring emergent needle decompression, and therapy should never be delayed for x-ray confirmation. Pleural cavity (or intrapleural) pressure is negative as compared to lung pressure and atmospheric pressure. Other symptoms may include substernal chest pain, usually radiating to the neck, back, or shoulders and exacerbated by deep inspiration, coughing, or supine positioning; dyspnea; neck or jaw pain; dysphagia, dysphonia, and/or abdominal pain (unusual symptoms). Successful management of occult pneumothorax without tube thoracostomy despite positive pressure ventilation. Respiration. Pneumothorax and pregnancy. This chest radiograph has 2 abnormalities: (1) tension pneumothorax and (2) potentially life-saving intervention delayed while waiting for x-ray results. 10. Noppen M, Dekeukeleire T, Hanon S, Stratakos G, Amjadi K, Madsen P, et al. Almoosa KF, Ryu JH, Mendez J, Huggins JT, Young LR, Sullivan EJ, et al. Fluorescein-enhanced autofluorescence thoracoscopy in patients with primary spontaneous pneumothorax and normal subjects. Patients with pneumothorax can be either asymptomatic or symptomatic. These trauma patients may have multiple tissue contusions and laserations. [Full Text]. Spontaneous pneumothorax associated with ankylosing spondylitis. The incidence is about 1to 13% but can increase up to 30% in certain situations. Am J Emerg Med. [QxMD MEDLINE Link]. Bedside sonography for detection of postprocedure pneumothorax. Zengerink I, Brink PR, Laupland KB, Raber EL, Zygun D, Kortbeek JB. Rheumatology (Oxford). . Leigh-Smith S, Harris T. Tension pneumothorax--time for a re-think?. Familial spontaneous pneumothorax. Martin M, Satterly S, Inaba K, Blair K. Does needle thoracostomy provide adequate and effective decompression of tension pneumothorax? Acad Emerg Med. 2001 Apr. [11] These numbers are lowerif procedures are done under ultrasound guidance. Chest wall thickness in military personnel: implications for needle thoracentesis in tension pneumothorax. 4 (4):235-8. Dente CJ, Ustin J, Feliciano DV, Rozycki GS, Wyrzykowski AD, Nicholas JM, et al. Atraumatic pneumothoraces are further divided into primary (unknown etiology) and secondary (patient with an underlyingpulmonary disease). Signs such as seatbelt sign or steering wheel deformity are indicators for high-energy blunt thoracic trauma. Clinical manifestations of tension pneumothorax: protocol for a systematic review and meta-analysis. As a result, hypoxemia, acidosis, and decreased cardiac output can lead to cardiac arrest and, ultimately, death if the tension pneumothorax is not managed in a timely fashion. (2011) The Korean journal of thoracic and cardiovascular surgery. Imaging Chest x-ray [6] [8] Indications: all patients suspected of having pneumothorax As with pneumothorax, physical findings of pneumomediastinum may be variable, including absent signs in some patients. [msdmanuals.com] . [QxMD MEDLINE Link]. With time severe dyspnea, tachycardia and hypotension occur. In the case of iatrogenic or tension pneumothoraces in the hospital, this is usually in the ITU settings, the operating room, or a procedure suite. Spontaneous pneumothorax. Sihoe AD, Wong RH, Lee AT, Lau LS, Leung NY, Law KI, et al. Pneumothorax in the ICU: patient outcomes and prognostic factors. [QxMD MEDLINE Link]. Sedrakyan A, van der Meulen J, Lewsey J, Treasure T. Video assisted thoracic surgery for treatment of pneumothorax and lung resections: systematic review of randomised clinical trials. Marked depression of the right hemidiaphragm is noted, and mediastinal shift is to the left side, suggestive of tension pneumothorax. Hypoxia. Chest. Unlike the obvious patient presentations oftentimes used in medical training courses to describe a tension pneumothorax, actual case reports include descriptions of the diagnosis of the condition being missed or delayed because of subtle presentations that do not always present with the classically described clinical findings of this condition or the complexity of the patient with critical illness or injury. Share cases and questions with Physicians on Medscape consult. Knowledge of necessary emergency thoracic decompression procedures is essential for all healthcare professionals. Chest thoracostomy was performed, the patient was admitted, and talc pleurodesis was performed the next day. Tschopp JM, Rami-Porta R, Noppen M, Astoul P. Management of spontaneous pneumothorax: state of the art. [3][4][5][6], Early recognition of this condition is life-saving both outside the hospital and in modern ITUs. [QxMD MEDLINE Link]. J Subst Abuse. Access free multiple choice questions on this topic. [QxMD MEDLINE Link]. Thorax. 2001 Feb. 119 (2):590-602. [QxMD MEDLINE Link]. If multiple rib fractures occur along the midlateral (red arrows) or anterior chest wall (blue arrows), a flail chest (dotted black lines) may result, which may result in pneumothorax. Causes of traumatic pneumothorax include the following: Iatrogenic (induced by a medical procedure). Eur Respir J. 2006 Jul. Review the management options available for tension pneumothorax. Early recognition of this condition is life-saving both outside the hospital and in modern ITUs. Heart Lung. Ultrasound findings includethe absence of lung sliding and the presence of a lung point. Smoking and the increased risk of contracting spontaneous pneumothorax. Emerg Med J. Anesthesiology. J Trauma. 2007 Oct. 132 (4):1146-50. Shoaib Alam, MD is a member of the following medical societies: American College of Chest Physicians, American Thoracic Society, Society of Critical Care Medicine, International Society for Magnetic Resonance in Medicine, European Respiratory Society, Pennsylvania Thoracic SocietyDisclosure: Nothing to disclose. Tension pneumothorax can cause rapid progression of hypoxia, hypotension and shock. With blunt force trauma, a pneumothorax can occur if a rib fracture or dislocation lacerates the visceral pleura. [18][19], Traumatic pneumothorax occurs secondary to penetrating (e.g., gunshot wounds, stab wounds) or blunt chest trauma. That pressure gradient between the lung and pleural space prevents the lung from collapsing. Hypoxemia also triggers pulmonary vasoconstriction and increases pulmonary vascular resistance. In a supine patient, the examiner should lower themselves to be on a level with the patient. [QxMD MEDLINE Link]. There is atendency for the lung to recoilinward and the chest wall to recoil outward. Radiograph of a patient with idiopathic pulmonary fibrosis and a small pneumothorax, following video-assisted thoracoscopic surgery (VATS) lung biopsy. 2005 Dec. 44 (12):1538-41. The occult pneumothorax: what have we learned?. 37 (4): 819. 13 (3):209-10. Gonfiotti A, Santini PF, Jaus M, Janni A, Lococo A, De Massimi AR, et al. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvNDI0NTQ3LWNsaW5pY2Fs, Respiratory distress (considered a universal finding) or respiratory arrest, Tachypnea (or bradypnea as a preterminal event), Asymmetric lung expansion - A mediastinal and tracheal shift to the contralateral side can occur with a large tension pneumothorax, Distant or absent breath sounds - Unilaterally decreased or absent lung sounds is a common finding, but decreased air entry may be absent even in an advanced state of the disease, Lung sounds transmitted from the unaffected hemithorax are minimal with auscultation at the midaxillary line, Hyperresonance on percussion - This is a rare finding and may be absent even in an advanced state of the disease, Adventitious lung sounds (crackles, wheeze; an ipsilateral finding), Tachycardia - This is the most common finding. Shah K, Tran J, Schmidt L. Traumatic pneumothorax: updates in diagnosis and management in the emergency department. [QxMD MEDLINE Link]. 62 (6):1384-9. (2004) ISBN:0781736552. Administration of 100% supplemental oxygen can help reduce the size of the pneumothorax bydecreasing the alveolar nitrogen partial pressure. This leads to lung collapse. Only 1.25% of the air is absorbed without oxygen in 24 hours. Plewa MC, Ledrick D, Sferra JJ. [QxMD MEDLINE Link]. 1989 Jul. In the case of trauma, this usually happens outside the hospital or in the emergency department (ED). Symptoms may include diaphoresis, splinting chest wall to relieve pleuritic pain, and cyanosis (in the case of tension pneumothorax). 10 (4):R112. Eur Respir J. Chest. A tension pneumothorax occurs due to the progressive accumulation of intrapleural gas in thoracic cavity caused by a valve effect during inspiration/expiration. [QxMD MEDLINE Link]. Brander L, Takala J. Tracheal tear and tension pneumothorax complicating bronchoscopy-guided percutaneous tracheostomy. 2005 Nov. 22 (11):788-9. Wax DB, Leibowitz AB. Huang TW, Lee SC, Cheng YL, Tzao C, Hsu HH, Chang H, Chen JC. Treatment options and long-term results. Advertisement Lopes JA, Frankel HL, Bokhari SJ, Bank M, Tandon M, Rabinovici R. The trauma bay chest radiograph in stable blunt-trauma patients: do we really need it?. [QxMD MEDLINE Link]. [Full Text]. Comparison of the efficacy of novel two covering methods for spontaneous pneumothorax: a multi-institutional study. Signs and symptoms of tension pneumothorax are usually more impressive than those seen with a simple pneumothorax, and clinical interpretation of these is crucial for diagnosing and treating the condition. 342 (12):868-74. 1993. [8][23][24][25][26][27], Tension pneumothorax can occur anywhere, and treatment depends on the circumstance at the time of onset. The timely and accurate evaluation leadsto early interventions decreasing mortality and morbidity. Catamenial pneumothorax revisited: clinical approach and systematic review of the literature. Symptoms of iatrogenic pneumothorax are similar to those of a spontaneous pneumothorax and depend on the age of the patient, the presence of underlying lung disease, and the extent of the pneumothorax. Late signs include distended neck veins, tracheal deviation, and cyanosis. [QxMD MEDLINE Link]. [9][10][14][11][15], Before understanding the pathophysiology of tension pneumothorax, it is essential to understand normal lung physiology. Pneumothoraces can be traumatic or atraumatic. No study has shown that the number or size of blebs and bullae found in the lung can be used to predict recurrence. Tension pneumothorax arises from many causes and rapidly progresses to respiratory insufficiency, cardiovascular collapse, and ultimately death if not recognized and treated. 2007 Jan. 188 (1):37-41. Schramel FM, Postmus PE, Vanderschueren RG. Chemical pleurodesis options includetalc, minocycline, doxycycline, or tetracycline. The diagnosis may become evident only if the patient is receiving positive-pressure ventilation. Decreased or absent breath sounds on the affected side. [QxMD MEDLINE Link]. 2011 May. In secondary pneumothorax (SSP), the chest pain is more likely to persist with more significant clinical symptoms. Worsening pneumothorax Positive-pressure ventilation can lead to increased air in the chest cavity without a route of escape, worsening a pneumothorax and possibly leading to a tension pneumothorax. During video-assisted thoracic surgery (VATS), pneumothorax is treated with pleurodesis. Flume PA, Strange C, Ye X, Ebeling M, Hulsey T, Clark LL. Haraguchi S, Fukuda Y. Histogenesis of abnormal elastic fibers in blebs and bullae of patients with spontaneous pneumothorax: ultrastructural and immunohistochemical studies. Thorax. 1993 Feb. 103 (2):433-8. Blunt traumatic occult pneumothorax: is observation safe?--results of a prospective, AAST multicenter study. 2007 Dec. 172 (12):1260-3. 56 (3):527-30. [QxMD MEDLINE Link]. The incidence is 5to 7 per 10,000 hospital admissions. However, the risk of lung re-expanding quickly increases the risk of pulmonary edema. Charles W. Lanks, Vanessa Correa. The first-line responders when a patient develops a traumatic or tension pneumothorax vary depending on the situation and underlying etiology. [QxMD MEDLINE Link]. 2009 Jun. Women aged 30-40 years who present with onset of symptoms within 48 hours of menstruation, right-sided pneumothorax, and recurrence raise suspicion for catamenial pneumothorax. Bense L, Eklund G, Wiman LG. Close radiographic view of patient with a small spontaneous primary pneumothorax (same patient as from the previous image). Penetrating chest wounds must be covered with an airtight occlusive bandage and clean plastic sheeting. 2007 Jun. When mediastinal shifts accompany it, it is called a tension pneumothorax. Lal A, Anderson G, Cowen M, Lindow S, Arnold AG. Computed tomography scan demonstrating a bulla in an asymptomatic patient. A sudden attack of chest pain is often the first symptom. Experience with 114 patients. Am Surg. 3. [Full Text]. 1989 Jun. In: StatPearls [Internet]. The initial assessment involves a chest radiograph (CXR) to confirm the diagnosis.[21]. 2004 Jun. Zanobetti M, Poggioni C, Pini R. Can chest ultrasonography replace standard chest radiography for evaluation of acute dyspnea in the ED?. Image courtesy S.Bhimji MD, left sided tension pneumothorax. This rise in pressure further compresses the lung and decreases its volume. [Full Text]. [QxMD MEDLINE Link]. Radiograph of a patient with spontaneous primary pneumothorax due to a left upper lobe bleb. The first rib is often fractured posteriorly (black arrows). On examination, breath sounds are absent on the affected hemothorax and the trachea deviates away from the affected side. J Trauma. Eguchi M, Abe T, Tedokon Y, Miyagi M, Kawamoto H, Nakasone Y. In any patient presenting with chest trauma,airway, breathing, and circulation should be assessed. Insertion of chest tube. [QxMD MEDLINE Link]. 2022 Apr 15. Acta Pathol Jpn. J Trauma. StatPearls Publishing, Treasure Island (FL). 1993. 2004 Jul. Radiograph depicting a right-sided iatrogenic pneumothorax after transbronchial biopsy. If a patient is hemodynamically unstable with a high clinical suspicion of pneumothorax, needle decompression, or tube thoracostomy must be done immediately. 1997 Sep. 112 (3):789-804. [QxMD MEDLINE Link]. Melton LJ, Hepper NG, Offord KP. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Cardiac tamponade can clinically mimic tension pneumothorax. It is most commonly encountered in the prehospital, emergency department, and intensivetherapyunit (ITU) settings. The thorax may also be hyperresonant; jugular venous distention and tachycardia may be present. Rodriguez RM, Hendey GW, Marek G, Dery RA, Bjoring A. a. If a chest tube is malpositioning or becomes plugged, it can cease to function, and the pneumothorax can recur. 22 (2):101; author reply 101-2. 2003 Jun. Chest tubes are usually managed by experienced nurses, respiratory therapists, surgeons, and ITU physicians. Causes of tension pneumothorax Trauma to the chest, including a punctured lung, is the usual cause of a tension pneumothorax. Marquette CH, Marx A, Leroy S, Vaniet F, Ramon P, Caussade S, et al. Sharma A, Jindal P. Principles of diagnosis and management of traumatic pneumothorax. Management of emergency department patients with primary spontaneous pneumothorax: needle aspiration or tube thoracostomy?. Occasionally, the tension pneumothorax may be tolerated and its diagnosis delayed for hours to days after the initial insult. 2009 Oct. 52 (5):E173-9. British Thoracic Society Fitness to Dive Group, Subgroup of the British Thoracic Society Standards of Care Committee. 2012 Oct. 30 (8):1407-13. J Ultrasound Med. In some instances, subcutaneous emphysema can also be seen. 280 (18):1563-4. Gunji Y, Akiyoshi T, Sato T, Kurihara M, Tominaga S, Takahashi K, et al. When examining a patient for suspected tension pneumothorax, any clue may be helpful, as subtle thoracic size and thoracic mobility differences may be elicited by performing careful visual inspection along the line of the thorax. Rezende-Neto JB, Hoffmann J, Al Mahroos M, Tien H, Hsee LC, Spencer Netto F, et al.
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