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What is Tension Pneumothorax?

By D. Jeffress
Updated May 17, 2024
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Tension pneumothorax is the medical term for a collection of air that becomes trapped in the chest cavity and causes lung collapse. Most cases are caused by direct trauma to the neck or chest, as can occur during an automobile accident. Tension pneumothorax is a medical emergency that must be treated right away in order to prevent total respiratory failure, shock, and heart 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 tear, however, pressure rapidly builds and compresses the lungs. The injured lung collapses and the pressure buildup constricts blood vessels leading to the heart. As a result, blood tends to pool and the heart is robbed of oxygenated blood. Shock and cardiac failure are likely when tension pneumothorax is not treated right away.

Tension pneumothorax can be caused by many different factors. Direct injuries can be acquired with blunt trauma to the chest or an accidental puncture during a medical or surgical procedure. People who suffer from severe asthma, chronic respiratory diseases, and cystic fibrosis are at a much higher risk of tension pneumothorax. The condition is also fairly common in premature newborns whose lungs never fully develop in the womb.

Signs that a person might be experiencing tension pneumothorax include very shallow or absent breathing, increased heart rate, and pale or blue-tinted skin. If tension pneumothorax occurs outside of a medical setting, there is little that bystanders can do to prevent serious complications besides calling an ambulance. Emergency medical responders quickly identify the signs of pneumothorax and perform needle decompression to relieve tension. A large hollow needle is inserted into the pleural cavity to give air an outlet. Once breathing becomes easier, the patient is transferred to a hospital for further treatment and evaluation.

In the hospital, oxygen therapy is administered and a breathing tube may be inserted to aid in respiration. Doctors take x-rays and computerized tomography scans to identify the cause of lung collapse and look for signs of damage to the heart, ribs, and other structures in the chest. Pooled blood and remaining air in the pleural space are extracted with a needle and a suction device. A patient usually needs to stay in the hospital for several days following treatment to limit the risk of repeat collapse.

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