🌟 Tension pneumothorax

 🎯 Pathology

• air in the pleural space

• the chest wall is damaged leading to the formation of a one-way valve that lets air into the pleural space but NOT out —> air enters the pleural space during inspiration and gets trapped during expiration —> air builds up pushing the mediastinum to the opposite side —> the great vessels will get compressed, compromising venous return to the heart —> cardiorespiratory arrest

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💡 Cause

• most common cause = mechanical ventilation in a patient with pleural injury

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🩺 Clinical features

• mediastinal shift —> tracheal deviation

• reduced breath sounds on the affected side

• hyper-resonant to percussion

• cardiorespiratory compromise —> hypotension, tachycardia and tachypnoea

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🕵️‍♂️ Investigations

• diagnosed clinically

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📌 How to measure the size of a pneumothorax

• initial management = needle decompression with a large-bore cannula (14G) at the 2nd intercostal space mid-clavicular

• definitive management = chest drain at the safe triangle

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💆‍♂️ Borders of the safe triangle​

• it is found in the mid-axillary line of the 5th intercostal space

• medial = lateral border of pectoralis major

• lateral = anterior border of latissimus dorsi

• inferior = a line superior to the horizontal level of the nipple

• superior = apex below the axilla