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Respiratory Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Ian Pavord, Nayia Petousi, Nick Talbot
Tension pneumothorax: A medical emergency that occurs when positive pressure builds up in the pleural space and results in mediastinal shift with breathlessness, hypoxaemia and eventually hypotension and shock secondary to impaired venous return. It is rare, but most commonly a complication of a traumatic pneumothorax or a pneumothorax during mechanical ventilation.
A motorcycle accident
Published in Tim French, Terry Wardle, The Problem-Based Learning Workbook, 2022
Approximately 5% of multiple trauma patients have pneumothoraces. Furthermore, a common cause for tension pneumothorax is positive pressure ventilation on a background of chest injury. In this scenario, right-sided chest injury with a fractured clavicle is likely to indicate underlying lung injury.
Thoracic Trauma
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
A tension pneumothorax develops when air accumulates in the pleural space. Unlike a simple pneumothorax, the air flow is predominantly unidirectional. Air flows into the pleural space on inspiration but cannot escape during expiration due to a ‘flap valve’ effect. This causes a progressive accumulation of air in the pleural space with collapse of the ipsilateral lung, producing hypoxia and eventually shifting of the mediastinum to the opposite side. There is reduced venous return from increased intrathoracic pressure, causing decreased cardiac output. In advanced cases, hypoxia-induced myocardial failure may further reduce cardiac output. Tension pneumothorax is a clinical diagnosis: its signs are given in Box 10.3; the last two are late signs.
Clinical Characteristics of Patients Undergoing Needle Thoracostomy in a Canadian Helicopter Emergency Medical Service
Published in Prehospital Emergency Care, 2022
Graham Newton, Gudrun Reay, Catherine M. Laing, Kathryn King-Shier
Pneumothorax has been reported in up to 50% of patients who suffer a significant traumatic injury to the chest (1). Tension pneumothorax is a life-threatening condition that can occur when enough air accumulates within the pleural space so that it collapses the affected lung, displaces the heart and trachea, thus decreasing venous return to the heart and ultimately reducing cardiac output (2). Tension pneumothorax is of particular concern during helicopter emergency medical services (HEMS) transport due to the relationship between increasing altitude and volume expansion of the pneumothorax (3). Needle thoracostomy (NT) is commonly used in the prehospital treatment of tension pneumothorax and has been described in literature specific to the air medical environment for over 25 years (4). Success rates using NT in a prehospital setting vary widely in the literature, from 5% to 96% (5–7).
Prehospital Pericardiocentesis Using a Pneumothorax Needle
Published in Prehospital Emergency Care, 2022
Aaron E. Robinson, Gregg A. Jones, Paul C. Nystrom, Adam Stirling, Kelsey Vanderbosch, Nicholas S. Simpson
The pericardiocentesis was not the only intervention performed prior to arrival at the hospital, so it cannot be solely credited for the return of spontaneous circulation. The most important factor was the teamwork put forth by prehospital providers and the rapid transport to a Level 1 Trauma Center. However, the only other interventions performed prehospital included IO placement, 50 mEq of sodium bicarbonate administration, supraglottic airway placement and ventilation, and bilateral chest needle decompression. There were no vasopressor agents or large volume fluids given. Positive pressure ventilation would provide oxygen but would have a detrimental effect on the patient’s already compromised cardiac output. Bilateral needle decompression may have played a role if there was tension pneumothorax. There was no difficulty ventilating the patient and no rush of air from the catheters throughout the resuscitation. Bilateral needle decompression was performed empirically in the setting of the arrest.
Complications from Needle Thoracostomy: Penetration of the Myocardium
Published in Prehospital Emergency Care, 2021
Arielle Thomas, K. Hope Wilkinson, Kevin Young, Timothy Lenz, Jillian Theobald
Needle thoracostomy is a potentially life-saving intervention performed when there is suspicion of a tension pneumothorax. A tension pneumothorax occurs when air rapidly accumulates in the extra-pleural space, which can result in respiratory distress and eventual cardiopulmonary arrest (1). Patients are usually treated based on a mechanism capable of causing a pneumothorax and the clinical picture of unequal breath sounds, decreased compliance during ventilation, and in more serious cases, hypotension (2, 3). The standard intervention is a 14-gauge angiocatheter that is placed in the second intercostal space at the MCL, however some teach placement in a lateral position, at the AAL at the 4th rib space, similar to tube thoracostomy. Needle thoracostomy is a temporizing procedure which must be exchanged for tube thoracostomy at the soonest availability.