Paramedics Course – Tension Pneumothorax

Tension Pneumothorax

Micro-lecture by the Australian Paramedical College

In today’s micro-lecture, APC Hon. Snr. Lecturer Sam Willis talks about Tension Pneumothorax which is accumulation of air in the pleural space under pressure which compresses the lungs thereby affecting the heart.


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Tension Pneumothorax Micro-lecture

In today’s micro-lecture we’re gonna talk about Tension Pneumothorax. Now Tension is something that you will have already read about in your units of study. You might have even attended the workshops whereby you will have heard about it again. But for those of you who are new to it, let’s go through what a Tension Pneumothorax actually is.

Now on this image, what you can see is a lung that’s fully expanded that has got no injuries to it on this side, on the patient’s right side. On the left side, you’ve got a lung here that’s been compressed by air. Now this air has entered the pleural space through either a rupture in the lung tissue itself or through a damage in the outside wall. And by damage it can be anything from a knife injury, a bullet injury, a fall from a height, anything that can rupture this delicate membranes whilst at the same time preventing the air from leaving in the normal mechanism. So for example, in this patient the air will be coming down the trachea, into the left main bronchus, into the lung and instead of it going back up this way, it’s actually going into this pleural cavity. So this is a pleural cavity.

On this uninjured lung, you can see there’s a space here, tiny little space, which is designed to allow us a special type of fluid to help the lung contract and expand. Whereas here, so basically that’s where the air is entering in a Tension Pneumothorax.

Now the reason it’s called a Tension Pneumothorax is because it’s been so badly compressed and squashed or quashed, that it’s pushing away from the side of the injury. So you can see that the trachea is bent and they call it mid-line shift. And eventually the heart will be badly impacted, and the heart will stop beating as well.

So as a paramedic, it’s your job to first and foremost recognize the signs and symptoms, which are down here. The patient will present with some kind of mechanism of injury of trauma. They will have a stabbing chest pain, which is worse when they breathe in. They will be short of breath. They will have a tachycardia, which is conducive with a sign of shock. So your typical signs of shock will be present. Shallow breathing, blue ashen skin because there’s oxygenation problems, and anxiety.

Now what the paramedic will do is they will do something called needle chest decompression, whereby they use a large-bore cannula and insert it into the second intercostal space on this side, so one/two, just above the third rib in the mid-clavicular line, and that will release the pressure. And in fact, you guys are taught this in Workshop Two.

Okay, so that’s a micro-lecture on Tension Pneumothorax.

I hope you’ve enjoyed it. Thank you for your attention. My name’s  Sam Willis and I look forward to talking to you again shortly.

Tension Pneumothorax Micro-lecture

Australian Paramedical College

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