![]() There is a tendency for the lung to recoil inward and the chest wall to recoil outward. That pressure gradient between the lung and pleural space prevents the lung from collapsing. Pleural cavity (or intrapleural) pressure is negative as compared to lung pressure and atmospheric pressure. īefore understanding the pathophysiology of tension pneumothorax, it is essential to understand normal lung physiology. A review of military deaths from thoracic trauma suggests that up to 5% of combat casualties with thoracic trauma have tension pneumothorax at the time of death. In cases of severe chest trauma, there is an associated pneumothorax 50% of the time. The incidence of traumatic pneumothorax depends on the size and mechanism of the injury. Patients with trauma tend to have an associated pneumothorax or tension pneumothorax 20% of the time. Tension pneumothoraces can develop in 1 to 2% of cases initially presenting with idiopathic spontaneous pneumothoraces. It is difficult to determine the actual incidence of tension pneumothorax as by the time trauma patients are transported to trauma centers, they have already received decompressive needle thoracotomies. Moreover, central venous catheter insertion was responsible for 13.2% of cases. 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. The incidence is 5 to 7 per 10,000 hospital admissions. Iatrogenic pneumothorax usually causes substantial morbidity but rarely death. The risk of pneumothorax is greater with failed access at the initial vein, a subclavian vein approach, and positive pressure ventilation. These numbers are lower if procedures are done under ultrasound guidance. The incidence is about 1 to 13% but can increase up to 30% in certain situations. Central venous catheterization increases the risk of pneumothoraces when placed in the internal jugular or subclavian. The rate of iatrogenic pneumothoraces is increasing in US hospitals as intensive care modalities have increasingly become dependent on positive pressure ventilation and central venous catheters. Traumatic and tension pneumothoraces are more common than spontaneous pneumothoraces. Traumatic and tension pneumothoraces are life-threatening and require immediate treatment. ![]() Knowledge of necessary emergency thoracic decompression procedures is essential for all healthcare professionals. Įarly recognition of this condition is life-saving both outside the hospital and in modern ITUs. ![]() It is most commonly encountered in the prehospital, emergency department, and intensive therapy unit (ITU) settings. 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. ![]() Tension pneumothorax is an uncommon condition with a malignant course that might result in death if left untreated. 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). Atraumatic pneumothoraces are further divided into primary (unknown etiology) and secondary (patient with an underlying pulmonary disease). 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. Traumatic pneumothoraces occur secondary to penetrating or blunt trauma, or they are iatrogenic. Pneumothoraces can be traumatic or atraumatic. ![]() This places pressure on the lung and can lead to its collapse and a shift of the surrounding structures. The air is outside the lung but inside the thoracic cavity. Pneumothorax is the collapse of the lung when air accumulates between the parietal and visceral pleura inside the chest. ![]()
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