Pneumothorax tension

It was emphasized that any thoracic penetration may result in acute life-threatening injuries such as tension pneumothorax, hemothorax, massive cardiac injury with tamponade, great vessel injury, hemoptysis, and lung coUapse. Thermoset mbber bullets can also cause serious injuries, as shown in Figure 7.2. 

SuccessM treatment of PEA and asystole depends almost entirely on diagnosis of the underlying cause. Potentially reversible causes include (1) hypovolemia, (2) hypoxia, (3) preexisting acidosis, (4) hyperkalemia, (5) hypothermia, (6) hypoglycemia, (7) drug overdose, (8) cardiac tamponade, (9) tension pneumothorax, (10) coronary thrombosis, (11) pulmonary thrombosis, and (12) trauma. 

When the cardiac electrical activity is maintained, but there is no mechanical output (pulseless electrical activity, electromechanical dissociation), then hypovolaemia, tension pneumothorax, pulmonary embolism, cardiac tamponade, and various forms of metabolic or pharmacological disturbance may be responsible. In asystole or pulseless electrical activity (with an underlying rate of less than 60 beats per minute) a single intravenous bolus of 3 mg atropine is recommended. 

An iatrogenic tension pneumothorax was the result of breast infiltration with lidocaine and adrenaline before an augmentation procedure (SEDA-20, 127). 

Tension pneumothorax History (asthma, ventilator, chronic obstructive pulmonary disease, trauma), no pulse with CPR, neck vein distention, tracheal deviation Needle decompression... 

Hypo/hyperkalaemia and other metabolic Hypothermia Tension pneumothorax Tamponade Toxins... 

Only immediately life-threatening injuries should be treated. An Asherman seal should be applied to any open wound and any suspected tension pneumothorax decompressed by needle thoracocentesis. 

Patients with pneumothorax present with shortness of breath, chest pain and cough. Tension pneumothorax may also occur, resulting in potentially fatal cardiovascular compromise with hypotension and death if untreated. 

Tension pneumothorax As above, plus Cyanosis Tracheal deviation Mediastinal shilf ... 

TTiere is a significant risk of tension pneumothorax, and if there is any suspicion of this, immediate needle decompression followed by tube thoracostomy should be carried out. Blood may be aspirated from the bronchial tree during intubation. Lung crepitations may be apparent on auscultation. The treatment for pneumothorax or haemopneumothorax is insertion of a wide-bore intercostal drain in the fifttr intercostal space in the anterior axillary line. Occasionally, local injury will necessitate placement in an alternative location. 

Needle decompression or chest tube insertion for tension pneumothorax. 

---