IAEM Clinical Guideline: Management of patients with tension pneumothorax in the emergency department [v1.0]
McCabe, Aileen; Gray, James; Moloney, Edward; Lane, Stephen
Undiagnosed tension pneumothorax is a readily treatable cause of cardiac arrest. Tension pneumothorax is a clinical diagnosis and should not require a chest X-ray to diagnose. This is a respiratory emergency and mandates prompt decompression.
Air is drawn into the pleural space with each inspiration and there is no escape of air during expiration. Pressure builds up in the intrapleural space such that the mediastinum is pushed over into the contralateral hemithorax along with compression of the great veins. The patient will progress to obstructive shock and further deteriorate to a cardiorespiratory arrest (PEA arrest typically) if not emergently treated by needle thoracocentesis.
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