ABSTRACT
This patient has a tension pneumothorax requiring urgent decompression. In tension pneumothorax, air enters the pleural space with each breath but cannot escape. Eventually, the pressure is sufficient to displace the mediastinum and compress the great vessels, resulting in circulatory collapse, cardiogenic shock and eventual death. Clinical findings in tension pneumothorax include tachypnoea, tachycardia, a trachea displaced away from the affected side, reduced chest wall movement on the affected side, hyper-resonance to percussion on the affected side and reduced breath sounds on the affected side. If a tension pneumothorax is suspected, it must be treated immediately without further investigation. To decompress the pneumothorax, a large-bore cannula should be inserted into the second intercostal space in the midclavicular line. When the cannula is in situ and the needle is removed, there should be a hiss of air to indicate decompression. Once the patient is stabilized, a formal chest drain with a water seal should be inserted.
