What is a tension pneumothorax? What are the symptoms?

When the intrathoracic pressure is higher than the atmospheric pressure during both the inhalation and exhalation phases, it is called tension pneumothorax. So what are the symptoms of tension pneumothorax? How to provide first aid in clinical practice?

1. Pathophysiology

It is common in the rupture of larger alveoli or larger and deeper lung lacerations or bronchial ruptures, the rupture of which is connected to the chest cavity and forms a valve. When you inhale, air enters the chest cavity through the fissure, and when you exhale, the valve closes, preventing the air in the chest cavity from returning to the airway and being discharged. The amount of air in the chest cavity continues to increase, and the pressure continues to rise, which is greater than the atmospheric pressure, compressing the injured lung and causing it to gradually collapse, and pushing the mediastinum to the healthy side, causing serious obstruction of respiratory and circulatory functions.

Sometimes the high-pressure air in the chest cavity is squeezed into the mediastinum and spreads to the subcutaneous tissue, forming subcutaneous emphysema in the neck, face, chest, etc.

2. Clinical manifestations

1. Symptoms: Extreme breathing difficulties, sitting and breathing; severe hypoxia may cause irritability, coma, and even suffocation.

2. Physical examination:

(1) Cyanosis.

(2) Subcutaneous emphysema may occur.

(3) Signs of pneumothorax.

(III) Auxiliary examination

1. Chest X-ray examination: There is a large amount of air accumulation in the chest cavity, the lung may be completely collapsed, and the trachea and heart shadows are shifted to the healthy side.

2. Thoracentesis: High-pressure air rushes out; after suction, the symptoms improve, but soon worsen again.

(IV) Emergency treatment: Tension pneumothorax is a critical illness that can quickly cause death.

1. Emergency treatment: Immediately exhaust the air to reduce the pressure in the chest cavity. Use a thick needle to pierce the chest cavity at the mid-clavicular line between the second intercostal space on the injured side to achieve the effect of exhausting the air and reducing the pressure. During the patient transfer process, tie a rubber finger cap on the connector of the insertion needle and cut a 1 cm opening on the top of the finger cap to act as a valve, which can exhaust air outward during exhalation and close during inhalation to prevent air from entering. Alternatively, connect one end of a long rubber tube or plastic tube to the inserted needle connector and place the other end under the water surface of a sterile water seal bottle to maintain continuous exhaust.

2. Formal treatment: Place a chest drainage tube at the highest point of gas accumulation (usually the second intercostal midclavicular line) and connect it to a water seal bottle. Sometimes a negative pressure suction device is needed to expel gas and promote lung expansion.

3. Use antibiotics to prevent infection.

4. After closed drainage, the lung fissure can usually be closed within 3 to 7 days. The tube can be removed only after the air leakage stops for 24 hours and X-ray examination confirms that the lungs have expanded.

5. Surgical treatment: Patients with long-term air leakage should undergo thoracotomy and repair. If the air leakage is still severe after chest intubation and the patient's breathing difficulties have not improved, it often indicates that the lacerations or ruptures of the lungs and bronchi are large, and thoracotomy should be performed as soon as possible to repair the lacerations, or perform lung segment or lobectomy.