Emergency care for pneumothorax

Mechanism of tension pneumothorax

Tension pneumothorax develops due to a flap tear of the lung tissue. This flap begins to act as a one-way valve:

• During inspiration, air flows freely into the pleural cavity.
• During expiration, the tissue flap closes the defect, blocking the exit of air.

As a result, there is a rapid accumulation of air in the pleural cavity. This causes collapse (compression) of the damaged lung. The increasing pressure leads to a shift of the mediastinal organs (including the heart and major blood vessels) to the opposite, healthy side, which in turn causes compression of the healthy lung as well.

Clinical presentation and diagnostics

The patient's condition deteriorates rapidly immediately after injury.

Main symptoms:

• Severe shortness of breath, pronounced chest pain, and a sense of anxiety.
• Pale skin with a bluish tint (cyanosis).
• Drop in blood pressure (hypotension), rapid heart rate (tachycardia), and weak pulse.

Physical examination findings:

• Inspection: The affected side of the chest lags behind during breathing, intercostal spaces are smoothed out.
• Percussion: Hyperresonance (tympanic note) is determined, the border of cardiac dullness is shifted to the healthy side.
• Auscultation: Breath sounds on the traumatized side are sharply diminished or completely absent.

Instrumental diagnostics: Confirmation of the diagnosis is carried out by imaging methods (targeted radiography, chest CT, or MRI). The images visualize free air in the pleural cavity, a collapsed lung, and a shift of the mediastinal shadow toward the intact side.

Treatment algorithm and quality criteria

The main emergency care measure for tension pneumothorax is an emergency pleural puncture. It is necessary for the immediate evacuation of accumulated air and reduction of intrapleural pressure.

As part of comprehensive treatment and medical care quality control (according to the checklist for patients with chest trauma):

1. Surgical treatment: Indicated for pneumothorax, hemothorax, chest organ injuries, flail chest (when skeletal stability is compromised due to fractures), and ongoing bleeding.
2. Diagnostics: Mandatory ultrasound of internal organs and diagnostic imaging.
3. Analgesia: Use of analgesics (NSAIDs, paracetamol, gabapentinoids, immediate-release opioids).
4. Antibiotic prophylaxis: To prevent the development of hospital-acquired pneumonia.
5. Rehabilitation: Ensuring airway patency and subsequent respiratory exercises (in case of fractures).

Class and exam questions

What else to study on this topic

• Pathophysiology of laryngeal stenosis
• Clinical stages of laryngeal stenosis
• Emergency conditions in thoracoabdominal trauma
• Technique of pleural puncture
• Hemorrhagic and hypovolemic shock
• Drugs for circulating blood volume restoration

Other topics in the "Additional Topics" section

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.