TENSION PNEUMOTHORAX
PATHOPHYSIOLOGY
Pneumothorax is a condition in which air enters the normally
closed space between the visceral and parietal pleura,
causing the collapse of lung tissue. The lung is dependent on
a “relative negative pressure” within the pleural space to
stay expanded. If a wound permits air to enter the pleural
space, it may also act as a one-way valve, producing a
condition called tension pneumothorax. Tension
pneumothorax is a progressive pneumothorax that enlarges,
builds pressure, and begins to infringe upon the function of
the opposite lung and the circulatory system.
SIGNS/SYMPTOMS OF TENSION PNEUMOTHORAX
Dyspnea
Diminished or absent breath sounds
Tracheal shift away from the side of injury
Distended neck veins
Apprehension, agitation, and/or decreased Level of
consciousness
Cyanosis
Signs and symptoms of shock
Subcutaneous emphysema
TREATMENT GOALS
EMT BASIC
Perform Initial Assessment
DO NOT DELAY TRANSPORT
LOAD AND GO
ALS intercept
High flow oxygen
Seal open chest wounds
If you have sealed a sucking chest wound – unseal it to relieve the
pressure
EMT INTERMEDIATE
I.V. (18G or larger), two started enroute to A.L.S.
EMT PARAMEDIC
Needle decompression in one of two possible sites. #1
Second intercostal space – midclavicular line or #2 Fifth
intercostal space – midaxillary line
HOSPITAL
Chest tube
Surgical repair of lung/chest wall
Sources:
1. American College of Emergency Physician’s Paramedic Field Care Textbook. 1997
2. Emergency Medicine – A Comprehensive Study Guide, ACEP 5th edition, 1999
3. Brady’s Paramedic Emergency Care, 3rd edition. 1997
Revised 12/1999