Ann Thorac Surg. If patients become hemodynamically unstable or have a cardiac arrest, there is a high suspicion of tension pneumothorax. On volume-control ventilation, this is indicated by marked increase in both peak and plateau pressures, with relatively preserved peak and plateau pressure difference. [12] Iatrogenic pneumothorax usually causes substantial morbidity but rarely death. Tension pneumothorax | Radiology Reference Article | Radiopaedia.org Murray and Nadel's Textbook of Respiratory Medicine. Pneumothorax Clinical Presentation - Medscape Radiograph of a new left-sided pneumothorax in a patient on mechanical ventilation, requiring high inflation pressures. Mary C Mancini, MD, PhD, MMM is a member of the following medical societies: American Association for Thoracic Surgery, American College of Surgeons, American Surgical Association, Phi Beta Kappa, Society of Thoracic SurgeonsDisclosure: Nothing to disclose. 35 (2):144-5. Zhang M, Liu ZH, Yang JX, Gan JX, Xu SW, You XD, et al. As with pneumothorax, physical findings of pneumomediastinum may be variable, including absent signs in some patients. J Trauma. A history of previous pneumothorax is important, as recurrence is common, with rates reported between 15% and 40%. Agitation with tachypnoea. Moreover, central venous catheter insertion was responsible for 13.2%of cases. That pressure gradient between the lung and pleural space prevents the lung from collapsing. Pneumomediastinum from barotrauma may result in tension pneumothorax and obstructive shock. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. 10 (6):1372-9. In secondary pneumothorax (SSP), the chest pain is more likely to persist with more significant clinical symptoms. Rojas R, Wasserberger J, Balasubramaniam S. Unsuspected tension pneumothorax as a hidden cause of unsuccessful resuscitation. The common symptoms and signs of tension pneumothorax include: Respiratory distress. [QxMD MEDLINE Link]. 5 (2):183-6. Jalota Sahota R, Sayad E. Tension Pneumothorax. Women aged 30-40 years who present with onset of symptoms within 48 hours of menstruation, right-sided pneumothorax, and recurrence raise suspicion for catamenial pneumothorax. Common findings include chest tenderness, ecchymoses, and respiratory distress; hypotension or shock may be present. Rapid detection of pneumothorax by ultrasonography in patients with multiple trauma. It is the most reliable imaging study for diagnosing pneumothorax, but it is not recommended for routine use. Pneumothorax, especially tension pneumothorax is fatal; complications that can occur due to pneumothorax and tube thoracostomy are: Diagnosing and managing traumatic and iatrogenic pneumothoraces require multidisciplinary coordination and teamwork. Rarely, it is a complication of traumatic pneumothorax, when a chest wound acts as a one-way valve that traps increasing volumes of air in the pleural space during inspiration. JAMA. Increased pulmonary artery pressures and decreased cardiac output or cardiac index are evidence of tension pneumothorax in patients with Swan-Ganz catheters. For a general discussion, refer to the pneumothoraxarticle. [QxMD MEDLINE Link]. Soldati G, Iacconi P. The validity of the use of ultrasonography in the diagnosis of spontaneous and traumatic pneumothorax. Pathogenesis and treatment of primary spontaneous pneumothorax: an overview. If patients who are mechanically ventilated are difficult to ventilate during resuscitation, high peak airway pressures are clues to pneumothorax. Tension pneumothorax is an uncommon condition with a malignant course that might result in death if left untreated. A non-tension pneumothorax is properly called a simple pneumothorax. Blunt trauma related chest wall and pulmonary injuries: An overview [QxMD MEDLINE Link]. Respir Med. Noppen M, Baumann MH. [37][38], Ventilator-related tension pneumothorax has been found to have dire outcomes and result in death more frequently. The chest pain is described as severe and/or stabbing, radiates to the ipsilateral shoulder and increases with inspiration (pleuritic). On pressure control ventilation, tension pneumothorax causes sudden drop in tidal volume. Radiologic assessment of potential sites for needle decompression of a tension pneumothorax. (2005) Emergency medicine journal : EMJ. Obstructive shock - Wikipedia In either case, as the collection grows further, it exerts a positive mass effect on the mediastinum (compression of vessels and heart) and the opposite lung. Haraguchi S, Fukuda Y. Histogenesis of abnormal elastic fibers in blebs and bullae of patients with spontaneous pneumothorax: ultrastructural and immunohistochemical studies. 10. Tension Pneumothorax: What Is It, Causes, Signs, Symptoms - Osmosis A tension pneumothorax causes progressive difficulty with ventilation as the normal lung is compressed. Korom S, Canyurt H, Missbach A, Schneiter D, Kurrer MO, Haller U, et al. 37 (4): 819. Henry M, Arnold T, Harvey J., Pleural Diseases Group, Standards of Care Committee, British Thoracic Society. Zhang M, Liu ZH, Yang JX, Gan JX, Xu SW, You XD, Jiang GY. 62 (6):1384-9. Michael G Benninghoff, DO, MS Attending Physician in Pulmonary and Critical Care Medicine, Christiana Medical Center Shoaib Alam, MD Staff Clinician, Pulmonary and Vascular Medicine, National Heart, Lung, and Blood Institute, National Institutes of Health Spontaneous pneumothorax associated with ankylosing spondylitis. Shabir Bhimji, MD, PhD is a member of the following medical societies: American Cancer Society, American College of Chest Physicians, American Lung Association, Texas Medical AssociationDisclosure: Nothing to disclose. Tension Pneumothorax - an overview | ScienceDirect Topics Which of the following assessment findings - Course Hero The most common underlying abnormality in secondary spontaneous pneumothorax is chronic obstructive pulmonary disease (COPD), and cystic fibrosis carries one of the highest associations, with more than 20% reporting spontaneous pneumothorax. In addition to the sonographic features of pneumothorax, a RUSH exam (often performed in the setting of hemodynamic instability) the following features imply the presence of tension physiology 8: Treatment of a tension pneumothorax is one of the classic medical emergencies where life can be saved or lost on the basis of recognition and subsequent rapid decompression. 2004 May. Recurrences are more common in smokers, COPD, and patients with acquired immunodeficiency syndrome (AIDS). [Guideline] MacDuff A, Arnold A, Harvey J, BTS Pleural Disease Guideline Group. [QxMD MEDLINE Link]. Presentation is variable and may initially have no symptoms. Can J Surg. Computed tomography scan demonstrating blebs in a patient with chronic obstructive pulmonary disease (COPD). Tension pneumothorax has been reported during surgery with both single- and double-lumen tubes. Needle decompression is done at the second intercostal space in the midclavicular line above the rib with an angio-catheter. This. Reference article, Radiopaedia.org (Accessed on 01 May 2023) https://doi.org/10.53347/rID-15362, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":15362,"questionManager":null,"mcqUrl":"https://radiopaedia.org/articles/tension-pneumothorax/questions/870?lang=us"}, View Frank Gaillard's current disclosures, see full revision history and disclosures, dilation (>2.1 cm) and absence of variation with respiration imply a pathologically elevated CVP, consistent with obstructive, hyperdynamic right heart with underfilling, the right ventricular diameter will be reduced as a result of the reduction in filling/preload. Clinical characteristics, hospital outcome and prognostic factors of patients with ventilator-related pneumothorax. 5 (3):181-2. Slater A, Goodwin M, Anderson KE, Gleeson FV. Occasionally, it can have a subtle presentation too. Bedside sonography for detection of postprocedure pneumothorax. A tension pneumothorax will have the same features as a simple pneumothorax with a number of additional features, helpful in identifying tension. (2010) Emergency medicine clinics of North America. Am J Respir Crit Care Med. 14G intravenous cannula) can be inserted, typically in the 2nd intercostal space in the midclavicular line, to gain valuable time, before a larger underwater drain can be inserted 1. Gupta D, Hansell A, Nichols T, Duong T, Ayres JG, Strachan D. Epidemiology of pneumothorax in England. Traumatic mediastinum, although present in up to 6% of patients, does not portend serious injury. Chest. Tension pneumothorax with pneumopericardium. StatPearls Publishing, Treasure Island (FL). 139 (5):1140-1147. Eguchi M, Abe T, Tedokon Y, Miyagi M, Kawamoto H, Nakasone Y. [QxMD MEDLINE Link]. Explain the importance of improving care coordination among interprofessional team members to provide the best outcomes for patients with tension pneumothorax. 2006 Jul. Vinson DR, Ballard DW, Hance LG, Stevenson MD, Clague VA, Rauchwerger AS, Reed ME, Mark DG., Kaiser Permanente CREST Network Investigators. [QxMD MEDLINE Link]. J Trauma. Tabakoglu E, Ciftci S, Hatipoglu ON, Altiay G, Caglar T. Levels of superoxide dismutase and malondialdehyde in primary spontaneous pneumothorax. [QxMD MEDLINE Link]. This rise in pressure further compresses the lung and decreases its volume. J Subst Abuse. 47 (5):415-8. Resuscitation. Chest thoracostomy was performed, the patient was admitted, and talc pleurodesis was performed the next day. Noppen M, Dekeukeleire T, Hanon S, Stratakos G, Amjadi K, Madsen P, et al. Emerg Med J. Insertion of chest tube. Obstruction can occur at the level of the great vessels or the heart itself. [QxMD MEDLINE Link]. 56 (3):527-30. [18][19], Traumatic pneumothorax occurs secondary to penetrating (e.g., gunshot wounds, stab wounds) or blunt chest trauma. ISBN:110702191X. In these situations, care coordination is vital, and having different team members trained and ready to act promptly is life-saving. Chest. 2006 Mar. [8], Tension pneumothorax is common in ITU-ventilated patients. Shields TW. Chest. Tension pneumothorax is a potentially life-threatening condition that medical professionals must treat as a medical emergency. [QxMD MEDLINE Link]. 2006 Jul 1. Other symptoms may include substernal chest pain, usually radiating to the neck, back, or shoulders and exacerbated by deep inspiration, coughing, or supine positioning; dyspnea; neck or jaw pain; dysphagia, dysphonia, and/or abdominal pain (unusual symptoms). Chest radiograph depicting tension and traumatic pneumothorax. Eur Respir J. Delius RE, Obeid FN, Horst HM, Sorensen VJ, Fath JJ, Bivins BA. 6th ed. Chen KC, Chen PH, Chen JS. However, subcutaneous emphysema is the most consistent sign. Perera P, Mailhot T, Riley D, Mandavia D. The RUSH exam: Rapid Ultrasound in SHock in the evaluation of the critically lll. We describe a case of a healthy middle-aged woman, who was planned to receive general anaesthesia for total thyroidectomy. Patients with trauma tend to have an associated pneumothorax or tension pneumothorax 20% of the time. encoded search term (Pneumothorax) and Pneumothorax, Sudden-Onset Chest Pain in an 80-Year-Old Man With COPD. Prospective evaluation of thoracic ultrasound in the detection of pneumothorax. Am Surg. If multiple rib fractures occur along the midlateral (red arrows) or anterior chest wall (blue arrows), a flail chest (dotted black lines) may result, which may result in pneumothorax. [QxMD MEDLINE Link]. British Thoracic Society Fitness to Dive Group, Subgroup of the British Thoracic Society Standards of Care Committee. : Cardiac arrest ultra-sound exam--a better approach to managing patients in primary non-arrhythmogenic cardiac arrest. Dalton AM, Hodgson RS, Crossley C. Bochdalek hernia masquerading as a tension pneumothorax. The diagnosis of tension pneumothorax must be made immediately through clinical assessment as waiting for imaging, if not readily available, maydelaymanagement and increase mortality.[8][18][20]. Life-Threatening Simultaneous Bilateral Spontaneous Tension Pneumothorax - A case report -. Surgeon-performed ultrasound for pneumothorax in the trauma suite. Whale C, Hallam C. Tension pneumothorax related to acupuncture. Terada T, Nishimura T, Uchida K, Hagawa N, Esaki M, Mizobata Y. Iannoli ED, Litman RS. The air is outside the lung but inside the thoracic cavity. Experience with 114 patients. Efficacy of follow-up evaluation in penetrating thoracic injuries: 3- vs. 6-hour radiographs of the chest. Tension pneumothorax can result in rapid development of severe symptoms associated with tracheal deviation away from the pneumothorax, tachycardia, and hypotension. Catheter aspiration for simple pneumothorax. Rezende-Neto JB, Hoffmann J, Al Mahroos M, Tien H, Hsee LC, Spencer Netto F, et al. [Guideline] British Thoracic Society Fitness to Dive Group, Subgroup of the British Thoracic Society Standards of Care Committee. Increased work of breathing b. Unilaterally diminished breath sounds c. Pleuritic chest pain d. Hypotension that worsens with inspiration. The diagnosis may become evident only if the patient is receiving positive-pressure ventilation. [13], Tension pneumothoraces can developin 1to 2% of cases initially presenting with idiopathic spontaneous pneumothoraces. Clinical Presentation of Patients With Tension Pneumothorax: A Systematic Review. Paydar S, Ghahramani Z, Ghoddusi Johari H, Khezri S, Ziaeian B, Ghayyoumi MA, Fallahi MJ, Niakan MH, Sabetian G, Abbasi HR, Bolandparvaz S. Tube Thoracostomy (Chest Tube) Removal in Traumatic Patients: What Do We Know? The timely and accurate evaluation leadsto early interventions decreasing mortality and morbidity. Rarely, it is a complication of traumatic pneumothorax, when a chest wound acts as a one-way valve that traps increasing volumes of air in the pleural space during inspiration. Contributed by Scott Dulebohn, MD, Tension pneumothorax. If the patient is stable, then diagnostic imaging (i.e., CXR) can be done prior to treatment. Ferrie EP, Collum N, McGovern S. The right place in the right space? Which of the follow assessment finding differentiates a tension pneumothorax from a simple pneumothorax? 2006 Mar. Zhongguo Zhen Jiu. 1997 Jun. 2000 Mar 23. Pneumothorax - Knowledge @ AMBOSS Traumatic and tension pneumothoraces are life-threatening and require immediate treatment.[7]. Hypoxia. Note the right-sided pneumothorax induced by the incorrectly positioned small-bowel feeding tube in the right-sided bronchial tree. 2001 Feb. 50 (2):201-5. The endotracheal tube is in a good position. Kazerooni EA, Gross BH. Management of emergency department patients with primary spontaneous pneumothorax: needle aspiration or tube thoracostomy?. Ultrasound is about 94% sensitive and 100% specific with a skilled operator. [QxMD MEDLINE Link]. However, tension pneumothorax can cause severe hypotension, and open pneumothorax can compromise ventilation. As the pressure increases, it will cause the mediastinum to shift towards the contralateral side, contributing further to hypoxemia. Tension pneumothorax is a life-threatening condition caused by the continuous entrance and entrapment of air into the pleural space, thereby compressing the lungs, heart, blood vessels, and other structures in the chest. Tension Pneumothorax - Injuries and Poisoning - Merck Manuals Consumer Chest Radiograph Tension Pneumothorax. Am J Emerg Med. Once the patient is stabilized, this condition is managed by an interdisciplinary team, and input from each member is critical for successful patient outcomes. Diagnosis and management of traumatic and tension pneumothoraces require a high level of cooperation among interprofessional healthcare team members. van den Brande P, Staelens I. Fluorescein-enhanced autofluorescence thoracoscopy in patients with primary spontaneous pneumothorax and normal subjects. 2006 Jan. 72 (1):31-4. With tension pneumothorax, patients will have signs of hemodynamic instability with hypotension and tachycardia. While this is a commonly considered cause of shock in obvious trauma, it can also occur non-traumatically in ventilated patients, or in the setting of occult trauma. Lateral radiograph demonstrating tension and traumatic pneumothorax. In a recent study, 95% of pneumothorax episodes were observed to be iatrogenic; of these, barotrauma secondary to mechanical ventilation resulted in 69.6% of cases, 41.1% of which were tension pneumothoraces. Leigh-Smith S, Harris T. Tension pneumothorax--time for a re-think?. [Full Text]. Tension pneumothorax is characterized by injured tissue which forms a one-way valve allowing air inflow in pleural space with inhalation and prohibiting an air outflow. Martin M, Satterly S, Inaba K, Blair K. Does needle thoracostomy provide adequate and effective decompression of tension pneumothorax? Tracheal deviation is an inconsistent finding. Ann Emerg Med. On lung auscultation, decreased or absent breath sounds on the ipsilateral side, reduced tactile fremitus, hyper-resonant percussion sounds, and possible asymmetrical lung expansion are suggestive of pneumothorax. Which of the follow assessment finding differentiates a tension Positive pressure ventilation should be avoided initially, as it will increase the tension pneumothorax's size. Injury. BMJ. 1993 Dec. 43 (12):709-22. [QxMD MEDLINE Link]. If on mechanical ventilation, the airway pressure alarms are triggered. 255 (3):440-5. The first-line responders when a patient develops a traumatic or tension pneumothorax vary depending on the situation and underlying etiology. Philadelphia: Elsevier Saunders; 2016. Tension pneumothorax can cause rapid progression of hypoxia, hypotension and shock. Zengerink I, Brink PR, Laupland KB, Raber EL, Zygun D, Kortbeek JB. [Full Text]. 1989 Dec. 96 (6):1302-6. [QxMD MEDLINE Link]. 2002 Mar. [11] These numbers are lowerif procedures are done under ultrasound guidance. . Risk factors and treatment. With time severe dyspnea, tachycardia and hypotension occur. Bedside sonography for detection of postprocedure pneumothorax. Patients with high peak inspiratory pressure are at greater risk of tension pneumothorax. A pneumothorax is an abnormal collection of air in the pleural space between the lung and the chest wall. 1987 Dec. 92 (6):1009-12. Young and otherwise healthy patients can tolerate the main physiologic consequences of a decrease in vital capacity and partial pressure of oxygen fairly well, with minimal changes in vital signs and symptoms, but those with underlying lung disease may have respiratory distress. Clinical signs of a tension pneumothorax in the ventilated patient are comparably rapid, with arterial and mixed venous peripheral capillary oxygen saturation immediately decreasing 5. In some instances, subcutaneous emphysema can also be seen. In a retrospective review of cases presenting to an academic medical center, 67% of identified patients had chest pain; 42% had persistent cough; 25% had sore throat; and 8% had dysphagia, shortness of breath, or nausea/vomiting. This is a chest radiograph of an elderly male with chronic obstructive pulmonary disease who presented with a second left-sided spontaneous pneumothorax in 2 months. There are two types of pleurodesis: mechanical and chemical. Michael G Benninghoff, DO, MS is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Osteopathic Association, American Thoracic Society, Society of Critical Care MedicineDisclosure: Nothing to disclose. [Full Text]. van den Brande P, Staelens I. [1][2] It is a severe condition that results when air is trapped in the pleural space under positive pressure, displacing mediastinal structures and compromising cardiopulmonary function. 4. What Can We Do? Delayed tension pneumothorax complicating central venous catheterization and positive pressure ventilation. 2004 Oct 30. Thorax. In many patients who present with pneumomediastinum, it occurs as a result of endoscopy and small esophageal perforation. Signs such as seatbelt sign or steering wheel deformity are indicators for high-energy blunt thoracic trauma. Pneumomediastinum must be differentiated from spontaneous pneumothorax. Eckstein M, Suyehara D. Needle thoracostomy in the prehospital setting. Hyper-expansion. For example, intravenous antibiotics are included in the treatment of a pneumothorax that developed as a. Pneumothorax in polysubstance-abusing marijuana and tobacco smokers: three cases. BMJ Open Respir Res. Patients can be placed on positive pressure ventilation after a chest tube is placed. Brian J Daley, MD, MBA, FACS, FCCP, CNSC is a member of the following medical societies: American Association for the Surgery of Trauma, Eastern Association for the Surgery of Trauma, Southern Surgical Association, American College of Chest Physicians, American College of Surgeons, American Medical Association, Association for Academic Surgery, Association for Surgical Education, Shock Society, Society of Critical Care Medicine, Southeastern Surgical Congress, Tennessee Medical AssociationDisclosure: Nothing to disclose. Brook OR, Beck-Razi N, Abadi S, Filatov J, Ilivitzki A, Litmanovich D, et al. [QxMD MEDLINE Link]. Hypotension. 2011 Oct. 92 (4):1217-24; discussion 1224-5. Pneumothoraces are classified as simple (no shift of mediastinal structures), tension (shift in mediastinal structures present), or open (air passing through an open chest wound). Chemical pleurodesis options includetalc, minocycline, doxycycline, or tetracycline. [QxMD MEDLINE Link]. Severe acute respiratory syndrome complicated by spontaneous pneumothorax. A review of military deaths from thoracic trauma suggests that up to 5% of combat casualties with thoracic trauma have tension pneumothorax at the time of death. Tension pneumothorax occurs when the air enters the pleural space but cannot fully exit, similar to a one-way valve mechanism through the disrupted pleura or tracheobronchial tree. Chest. 1. [1][2]It is a severe condition that results when air is trapped in the pleural space under positive pressure, displacing mediastinal structures and compromising cardiopulmonary function. DORNHORST AC, PIERCE JW. Cyanosis and jugular venous distension can also be present. (2005) ISBN:0781745861. 2009 Mar. Rheumatology (Oxford). Lichtenstein D, Mezire G, Biderman P, Gepner A. A needle thoracostomy (e.g. Pneumothorax is a rare complication of thoracic central venous catheterization in community EDs. [3], On examination, it is essential to assess for signs of respiratory distress, including increased respiratory rate, dyspnea, and retractions. Yamashita H, Tsukayama H, Tanno Y, Nishijo K. Adverse events related to acupuncture. Blunt thoracic trauma patiens may have tracheal deviation and deformities of the chest wall may be observed. 28 (1): 29-56, vii. Immediately life threatening injuries - Trauma Victoria In the case of iatrogenic or tension pneumothoraces in the hospital, this is usually in the ITU settings, the operating room, or a procedure suite. Pneumothorax - Physiopedia Arao K, Mase T, Nakai M, Sekiguchi H, Abe Y, Kuroudu N, Oobayashi O. Concomitant Spontaneous Tension Pneumothorax and Acute Myocardial Infarction. 14-16. Computed tomography scan demonstrating secondary spontaneous pneumothorax (SSP) from radiation/chemotherapy for lymphoma. How emergency physicians choose chest tube size for traumatic pneumothorax or hemothorax: a comparison between 28Fr and smaller tube. Pneumothorax in cystic fibrosis. Thorax. 1989 Jul. [QxMD MEDLINE Link]. 1989 Jun. 54 (6):1254. All the above causes can further cause tension pneumothorax as well as: Traumatic and tension pneumothoraces are more common than spontaneous pneumothoraces. Illustration depicting multiple fractures of the left upper chest wall. [QxMD MEDLINE Link]. 23 Likewise, hypotension and a markedly widened pulse pressure should raise concerns for. It is a life-threatening occurrence requiring both rapid recognition and prompt treatment to avoid a cardiorespiratory arrest. Tsotsolis N, Tsirgogianni K, Kioumis I, Pitsiou G, Baka S, Papaiwannou A, Karavergou A, Rapti A, Trakada G, Katsikogiannis N, Tsakiridis K, Karapantzos I, Karapantzou C, Barbetakis N, Zissimopoulos A, Kuhajda I, Andjelkovic D, Zarogoulidis K, Zarogoulidis P. Pneumothorax as a complication of central venous catheter insertion. [QxMD MEDLINE Link]. Busch M. Portable ultrasound in pre-hospital emergencies: a feasibility study. Pneumothorax is when air collects in between the parietal and viscera pleurae resulting in lung collapse. Shabir Bhimji, MD, PhD Cardiothoracic and Vascular Surgeon, Saudi Arabia and Middle East Hospitals 2006 Jul. TNCC Exam 8th edition study Flashcards | Quizlet Greenberg's text-atlas of emergency medicine. Anxiety, cough, and vague presenting symptoms (eg, general malaise, fatigue) are less commonly observed. 5. At the time the article was created Frank Gaillard had no recorded disclosures. Tension pneumothorax most commonly occurs in patients receiving positive-pressure ventilation (with mechanical ventilation or particularly during resuscitation). Tschopp JM, Rami-Porta R, Noppen M, Astoul P. Management of spontaneous pneumothorax: state of the art. Chest tubes are usually managed by experienced nurses, respiratory therapists, surgeons, and ITU physicians. 13 (3):209-10. If the heart rate is faster than 135 beats/min, tension pneumothorax is likely, Hypotension - This should be considered as an inconsistently present finding; although hypotension is typically considered a key sign of a tension pneumothorax, studies suggest that hypotension can be delayed until its appearance immediately precedes cardiovascular collapse, Jugular venous distention - This is generally seen in tension pneumothorax, although it may be absent if hypotension is severe, Cardiac apical displacement - This is a rare finding, Radiograph of a patient with a small spontaneous primary pneumothorax. http://creativecommons.org/licenses/by-nc-nd/4.0/ [Full Text]. Almoosa KF, Ryu JH, Mendez J, Huggins JT, Young LR, Sullivan EJ, et al. [QxMD MEDLINE Link]. In stable patients, local anesthesia or adequate analgesia/sedation should be administered. This will cause the lung to collapse on the ipsilateral side. 20 (3):281-4. [QxMD MEDLINE Link].
tension pneumothorax hypotension that worsens with inspiration
