Tension Pneumothorax

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Pneumothorax is the collapse of the lung when air accumulates between the parietal and visceral pleura inside the chest. The air is outside the lung but inside the thoracic cavity. This places pressure on the lung and can lead to its collapse and a shift of the surrounding structures. Pneumothoraces can be traumatic or atraumatic. Traumatic pneumothoraces occur secondary to penetrating or blunt trauma or iatrogenic. Iatrogenic pneumothorax is a traumatic pneumothorax that results from injury to the pleura, with air introduced into the pleural cavity secondary to diagnostic or therapeutic medical intervention. Atraumatic pneumothoraces are further divided into primary (unknown etiology) and secondary (patient with an underlying pulmonary disease). Pneumothoraces are classified as simple (no shift of mediastinal structures), tension (shift in mediastinal structures present), or open (air passing through an open chest wound). A tension pneumothorax is a severe condition that results when air is trapped in the pleural space under positive pressure, displacing mediastinal structures, and compromising cardiopulmonary function. Early recognition of this condition is life-saving both outside the hospital and in modern ICU. Knowledge of necessary emergency thoracic decompression procedures are essential for all healthcare professionals. Traumatic and tension pneumothoraces are life-threatening and require immediate treatment.