A cannula was inserted into the 2nd intercostal space with apparent symptomatic improvement.
A large bore chest drain was inserted into the lateral chest wall to facilitate decompression. However, 1 hour later, symptoms of breathlessness have returned and heart rate has increased.
The chest drain is no longer swinging and the chest is hyper-resonant to percussion.
A smaller bore anterior chest drain is inserted and the patient is transferred to radiology for a CT.
This case demonstrates the common findings in tension pneumothorax:
- increased lucency on the side of the pneumothorax
- lung edge
- absence of lung markings peripherally
mediastinal shift away from the pneumothorax (indicating tension)
Prompt decompression and chest drain insertion is required, but assessment of the patient is key to ensure that when the chest drain is in place, it is working appropriately.
If there is clinical concern, reassessment of the patient and the drain must happen and further imaging may be required.