Tension pneumothorax is a medical emergency caused by air trapped in the chest cavity, leading to lung collapse and cardiac complications. Treatment involves oxygen therapy and needle decompression, followed by hospitalization for further evaluation and care. Direct trauma, respiratory diseases, and premature birth are common causes.
Tension pneumothorax is the medical term for a collection of air that becomes trapped in the chest cavity and causes the lungs to collapse. Most cases are caused by direct trauma to the neck or chest, such as can occur during an automobile accident. Tension pneumothorax is a medical emergency that must be treated immediately to prevent total respiratory failure, shock, and cardiac complications. Oxygen therapy is provided and specialized needles are used to remove air and blood from the chest cavity. With prompt treatment and follow-up care for other injuries, patients can often recover.
The open area around the lungs in the chest is called the pleural space. Normally, the pleural space is empty to allow for lung expansion during regular breathing. If air leaks into the pleural space from a lung injury, however, pressure builds up rapidly and compresses the lungs. The damaged lung collapses and the pressure buildup constricts the blood vessels that lead to the heart. As a result, blood tends to pool and the heart is deprived of oxygenated blood. Shock and heart failure are likely when tension pneumothorax is not treated immediately.
Tension pneumothorax can be caused by many different factors. Direct injuries can be acquired from blunt trauma to the chest or an accidental puncture during a medical or surgical procedure. People with severe asthma, chronic respiratory disease, and cystic fibrosis have a much higher risk of tension pneumothorax. The condition is also quite common in premature babies whose lungs never fully develop in the womb.
Signs that a person may have tension pneumothorax include very shallow or no breathing, increased heart rate, and pale or bluish skin. If tension pneumothorax occurs outside of a medical setting, there is little bystanders can do to prevent serious complications beyond calling an ambulance. Emergency responders quickly identify signs of pneumothorax and perform needle decompression to relieve tension. A large hollow needle is inserted into the pleural cavity to relieve the air. Once breathing becomes easier, the patient is transferred to the hospital for further treatment and evaluation.
In the hospital, oxygen therapy is given and a breathing tube may be inserted to aid breathing. Doctors do x-rays and computed tomography to identify the cause of the collapsed lung and look for signs of damage to the heart, ribs, and other structures in the chest. The collected blood and residual air in the pleural space are extracted with a needle and suction device. A patient usually needs to stay in the hospital for several days after treatment to limit the risk of a repeat collapse.
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