
Contents
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Introduction Introduction
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Treatment Treatment
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Step by Step Step by Step
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1. Suspect diagnosis of tension pneumothorax. 1. Suspect diagnosis of tension pneumothorax.
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2. Administer 100% oxygen. 2. Administer 100% oxygen.
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3. Rule out mainstem intubation. 3. Rule out mainstem intubation.
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4. Verify the diagnosis with chest x-ray and/or ultrasound. 4. Verify the diagnosis with chest x-ray and/or ultrasound.
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5. If cardiopulmonary compromise is present, start ACLS immediately. 5. If cardiopulmonary compromise is present, start ACLS immediately.
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6. Perform needle decompression (Figure 13.2). 6. Perform needle decompression (Figure 13.2).
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7. Remove the needle and leave the angiocatheter in place. 7. Remove the needle and leave the angiocatheter in place.
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8. If laparoscopy is being performed, look for a diaphragm breach and deflate the pneumoperitoneum. 8. If laparoscopy is being performed, look for a diaphragm breach and deflate the pneumoperitoneum.
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9. Stabilize the patient. 9. Stabilize the patient.
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10. Place a small-bore (8 to 14 French) drain. 10. Place a small-bore (8 to 14 French) drain.
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11. If needle decompression or drain placement fails, perform an open thoracostomy at AL5ICS. 11. If needle decompression or drain placement fails, perform an open thoracostomy at AL5ICS.
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12. Confirm decompression and drain placement. 12. Confirm decompression and drain placement.
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Other Management Considerations Other Management Considerations
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References References
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13 C13Tension Pneumothorax
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Published:September 2023
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Abstract
Tension pneumothorax is an emergency that requires timely diagnosis and management to prevent mortality. Any procedure that may violate the pleura can cause a pneumothorax, such as nerve blocks and surgical procedures in that area. Others are prone to pneumothorax simply due to their anatomy and physiology, including neonates undergoing mechanical ventilation, tall adolescents, and older patients with chronic obstructive pulmonary disease. Every anesthesiologist should be familiar with tension pneumothorax, which may present after the initiation of artificial, positive pressure ventilation. Here the approach is presented, including step-by-step guidance for needle decompression and definitive drain placement. The use of ultrasound is emphasized. Ultrasound is extremely useful for both diagnostic and therapeutic purposes. The rapid, sequential decision-making necessary to treat the disease in an optimal manner is presented chronologically. Thus, the latest thinking regarding ultrasound guidance; small-bore and conventional, open thoracostomy tube placement; and postprocedure management—and the reasoning underlying the treatment options—is discussed.
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