Tension Pneumothorax: Clinical Diagnosis and Needle Decompression

Tension pneumothorax is an emergency in which one-way air entry into the pleural space causes intrathoracic pressure to exceed atmospheric pressure and creates pressure on the mediastinum. Venous return decreases, cardiac output drops, and hemodynamic collapse develops.

Diagnosis is clinical; imaging is not awaited. Hypotension, unilateral loss of breath sounds, hyperresonance, jugular venous distension, and tracheal deviation are classic findings. In a ventilated patient, sudden peak pressure increase is an important sign.

Treatment begins with emergency needle decompression; a 14-gauge needle is placed in the 2nd intercostal space at the midclavicular line or in the 5th intercostal space at the anterior axillary line. Then tube thoracostomy is performed.