What makes this different from a normal pneumothorax?
In a tension pneumothorax, the pneumothorax is under pressure resulting in displacement of the mediastinum and potential cardiac compromise as venous return is reduced.
If you see this on a chest x-ray, what should you do next?
A tension pneumothorax should be decompressed promptly. So, let your senior know and consider decompressing the tension pneumothorax with a cannula placed in the 2nd intercostal space anteriorly.
After decompression, what should be done?
Despite decompression, tension pneumothoraces tend to recur. So, chest drain insertion should be performed to ensure that this does not happen.
Minor rotation and underinspired film.
No ECG leads, ET tube or chest drain.
Large left-sided pneumothorax with contralateral mediastinal shift indicating a tension pneumothorax. No pleural effusion.
This is a clinical emergency and the pneumothorax should be decompressed urgently (usually with a cannula in the 2nd intercostal space anteriorly).