Tension pneumothorax

Dr Craig Hacking and Assoc Prof Frank Gaillard et al.

A tension pneumothorax occurs when intrapleural air accumulates progressively in such a
way as to exert positive pressure on mediastinal and intrathoracic structures. It is a life
threatening occurrence requiring rapid recognition and treatment is required if
cardiorespiratory arrest is to be avoided.
For a general discussion, refer to the pneumothorax article.
Clinical presentation
Presentation is variable and may initially have no symptoms. With time severe dyspnea,
tachycardia and hypotension occur. Distended neck veins and tracheal deviation are also
often present. Eventually impaired venous return results in cardiac arrest and death. This can
occur within minutes.
Pathology
A tension pneumothorax occurs due to the progressive accumulation of intrapleural gas in
thoracic cavity caused by a valve effect during inspiration/ expiration. In this situation, the
ipsilateral lung will, if normal, collapse completely (although a less than normally compliant
lung may remain partially inflated). In either case as the collection grows further it exerts
positive mass effect on the mediastinum (compressing veins, and the heart) and the opposite
lung.
Radiographic features
A pneumothorax will have the same features as a run-of-the-mill pneumothorax with a
number of additional features, helpful in identifying tension. These additional signs indicate
over expansion of the hemithorax:

ipsilateral increased intercostal spaces

shift of the mediastinum to the contralateral side

depression of the hemidiaphragm

Treatment and prognosis

Treatment of a tension pneumothorax is one of the classic medical emergencies where a life
can be saved or loss on the basis of recognition and rapid decompression. Numerous
techniques exist, and the literature is replete with opinions, but in the first instance relieving
the tension, even if not draining the pneumothorax is life saving. A needle thoracostomy (e.g.
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

PENANGANAN TENSION PNEUMOTHORAX

Tension pneumothorax adalah kondisi collaps paru-paru yang komplit, karena udara yang
masuk selaput pleura, tidak bisa keluar lagi( trapped).
Kondisi gawat darurat ini perlu diperhatikan dalam ilmu kesehatan kerja.
PENYEBAB
Semua yang menimbulkan pneumothorax, bisa menjadi tension pneumothorax.
Pada pneumothorax biasa, udara yang masuk pleura, bisa keluar lagi dengan mudah.
Pada tension pneumothorax, udara yang dihirup, tidak bisa keluar dari pleura, dan makin
menekan paru-paru, sehingga jadi collaps.
Paru-paru yang collaps bisa makin menekan organ lain seperti : Jantung, Pembuluh darah dan
jalan napas.

GEJALA TENSION PNEUMOTHORAX

- Nyeri dada
- Sesak napas
- Kulit jadi membiru, karena kurang oxygen
- Nadi cepat/ takicardia
- Tensi turun / hipotensia
- Napas cepat
- Penurunan kesadaran
PEMERIKSAAN FISIK

- Vena dileher membengkak

- Suara bunyi napas menurun
- Auskultasi : bunyi Tympany
- Deviasi trachea tergeser oleh paru yang terkena tension.
- Dada yang terkena hyper expanded
- Sedikit gerakan napas
PENANGANAN TENSION PNEUMOTHORAX
- Chest decompression dengan needle thoracostomy.
- Cannula IV no 14 - 16 G ditusukan pada second rib space pada mid clavicular line.
- Jarum terus ditusukkan sampai udara diinspirasi masuk syringe .
- Jarum dicabut dan canula dibiarkan tetap di dada.
- Keluarnya udara dari cannula, menunjukkan bahwa betul ada tension pneumothorax.
- Manuver ini akan mengubah tension pneumothorax menjadi simple pneumothorax.
- Chest tube placement adalah pengobatan definitive untuk tension pneumothorax.