Tension Pneumothorax

Pneumothorax is air within the pleural space, causing lung collapse due to positive pleural pressure. Tension pneumothorax develops when this pressure is transmitted to the mediastinum (see . Left-Sided Tension Pneumothorax Radiograph). Although uncommon, this condition follows a malignant course and can result in death if untreated. Tension pneumothorax may present in prehospital settings, emergency departments, and intensive care units. The thorax comprises 3 compartments: the right and left pulmonary cavities and the centrally located mediastinum. The parietal pleura lines the pulmonary cavities, while the visceral pleura envelops the lungs. The pleural cavity, a potential space between these pleurae, normally contains serous fluid that lubricates the pleural surfaces. During inspiration, diaphragmatic depression and outward rib movement expand the lungs, facilitated by a slightly negative pleural pressure. Expiration involves diaphragmatic elevation and slight inward rib movement, with positive pleural pressure driving air out of the lungs. Disruption of the pleura can allow air to enter the pleural cavity. Elevated positive pleural pressure causes lung collapse, impairing oxygenation and ventilation of the affected lung. Excessive pleural pressure compresses mediastinal structures, including the heart, great vessels, and trachea. This process leads to tension pneumothorax, compromising respiration, venous return, and cardiac output. Early recognition and prompt management of tension pneumothorax are essential to prevent mortality. Proficiency in emergency thoracic decompression is a critical skill for all healthcare professionals.