Tension PTX - Pneumothorax

• Air can get into the pleura but cannot get out
• Medical Emergency
• Consequence
  • Pt dies of low CO (heart is squahsed)
  • Can cause Hypotension ↓(<90/60)
    • Spontaneous
      • generate very negative inspiratory pressure -> generate good venous return
      • Early respiratory presentation-> hypoxemia,
      • Late presentation of HTN
    • *PPV (intubated) PPV doesn’t necessarily mean intubated it just mean pt is not breathing on their own
      • Early presentation of HTN due to decreased venous return
• Investigation
  • POC US
• Treatment
  • Needle Decompression - 4th or 5th* ICS between anterior and mid axillary line, ABOVE rib
    • 14-18 Guage IV needle
    • *Old ACLS guideline says 2ed ICS, but apparently chest wall is thinner at 5th ICS
  • Once stabilized: Chest Tube + One-way valve
    • Most times, use chest tube directly