Today, a topic about which you may already believe you know all you need to know--chances are you don't. What we were taught about tension pneumo by textbooks and trauma courses may not be right. To discuss tension pneumothorax, there is no better guest than...

Dr. Simon Leigh-Smith

Consultant in Emergency Medicine, Defence Medical Services & NHS Lothian, Surgeon Commander Royal Navy, Clinical Lead for Pre-Hospital Care and Medic 1

Simon graduated from Liverpool in 1990 and had a varied training / experience including Commando, Para, GP, Emergency Medicine and Pre-Hospital/Retrieval before Consultant appointment in 2006. He has worked in Liverpool, Plymouth, Edinburgh, Portsmouth, London, Sydney, Kuwait, Iraq, Belize, Norway, Antarctic, South Atlantic, Iraq and Afghanistan. He has a strong interest in Tension Pneumothorax, Human Factors in team working and the delivery of excellent pre-hospital care to major trauma and critical illness. He loves all the usual ‘adventure sports’ but after he sailed around Cape Horn his wife and 2 daughters were glad to hear that he no longer wanted to sail around the world! He tries to exercise his Hungarian Vizsla (dog) whilst mountain biking but often feels guilty leaving her behind to go for long road rides…..

Tension Pneumothorax is 2 Diseases rather than 1

Awake/Spontaneously Breathing Patients

* Purely hypoxemic

* No hypotension until just before collapse

* May have long periods of compensation (though can also progress in minutes)

Ventilated Patients

* Sudden, both resp and cardiovascular disease

* Will be hypoxemic and hypotensive

Classic Signs are Rubbish

* Tracheal deviation is unreliable

* Breath Sounds are unreliable

* Chest wall observation signs are variable

* Need to go with clinical suspicion or ultrasound, radiograph, or empiric decompression

More on the Perils of Needle Decompression

* EMCrit Needle vs. Knife II

A Countervailing View

Simon's Publications

* Clinical Presentation of Patients With Tension Pneumothorax: A Systematic Review1

* Tension pneumothorax - time for a re-think.

* Slides from Full Lecture

Additional Reading and Info

* Pulmonary Artery Pressures with Tension

* Decreased cardiac index as an indicator of tension pneumothorax in the ventilated patient

1.

Roberts D, Leigh-Smith S, Faris P, et al. Clinical Presentation of Patients With Tension Pneumothorax: A Systematic Review. Ann Surg. 2015;261(6):1068-1078. https://www.ncbi.nlm.nih.gov/pubmed/25563887.