Tension Pneumothorax
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Tension Pneumothorax
A tension pneumothorax is a serious and potentially life-threatening medical emergency that occurs when air becomes trapped inside the chest cavity and cannot escape. As the trapped air builds up, pressure inside the chest increases and begins to compress the lungs, heart and major blood vessels.
This increasing pressure can rapidly affect both breathing and circulation, making early recognition and urgent medical treatment essential.
What Is a Tension Pneumothorax?
The lungs sit within the chest cavity and are surrounded by a thin space known as the pleural cavity. If this area becomes damaged, often due to chest trauma, air can leak into the pleural space.
When air continues to enter the chest but is unable to escape, pressure builds with every breath. This turns a simple pneumothorax into a tension pneumothorax, which is a medical emergency.
As pressure inside the chest increases:
- The affected lung may collapse
- The heart and major blood vessels can be pushed to the opposite side of the chest
- Blood flow around the body becomes restricted
- Breathing becomes increasingly difficult
- Obstructive shock and cardiac arrest may occur
Causes of Tension Pneumothorax
Tension pneumothorax most commonly develops following serious chest injury or trauma. Causes may include:
- Penetrating chest wounds
- Rib fractures
- Blast injuries
- Crush injuries
- Severe blunt trauma to the chest
In some cases, it may also develop from an untreated or worsening spontaneous pneumothorax.
Signs and Symptoms of Tension Pneumothorax
A casualty with a tension pneumothorax may deteriorate quickly. Common signs and symptoms include:
- Sudden severe chest pain
- Difficulty breathing or shortness of breath
- Rapid, shallow breathing
- Severe distress, anxiety or agitation
- Uneven chest movement
- Reduced chest expansion on one side
- Rapid heart rate
- Low blood pressure
- Pale, grey or bluish skin
- Confusion or reduced responsiveness
- Signs of shock
As oxygen levels fall and circulation worsens, the casualty may become increasingly drowsy or unresponsive.
Subcutaneous Emphysema
In some cases, air may escape into the tissues beneath the skin, causing a condition known as subcutaneous emphysema.
This may create a crackling or popping sensation under the skin around the chest, neck or shoulders when touched.
Emergency Treatment
A tension pneumothorax requires immediate emergency medical treatment to release the trapped air and reduce pressure within the chest.
This condition cannot be treated by standard first aid alone and requires advanced medical intervention.
First Aid Management
If you suspect a tension pneumothorax:
- Call 999 immediately
- Request urgent emergency medical assistance
- Keep the casualty calm and reassured
- Help them remain in a position that makes breathing easier, usually sitting upright
- Monitor breathing, circulation and responsiveness closely
- Be prepared for rapid deterioration
Do not leave the casualty unattended and continue to monitor their condition until emergency medical professionals arrive.
Importance of Early Recognition
For first aiders and first responders, recognising the signs of tension pneumothorax early can be lifesaving.
Rapid identification, immediate activation of emergency services and ongoing casualty support are essential in improving survival and reducing the risk of cardiac arrest.
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