Acute decrease oxygen saturation and tachycardia in this intubated ICU patient.
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Portable frontal radiography reveals a large right pneumothorax with marked shift of the mediastinum to the left as demonstrated by the leftward deviation of the endotracheal tube, trachea and cardiac silhouette.
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Tension pneumothorax is a medical emergency and defined as the presence of a pneumothorax AND hemodynamic compromise.
This intubated ICU patient developed spontaneous pneumothorax and was presumed to be iatrogenic due to high pressure ventilation. The left central venous catheter has been in place for several days without any complications and was not likely the cause of the pneumothorax.
A rough guideline for communicating the size of the pneumothorax to clinican is based on the maximal pleural separation from the chest wall: small (< 2cm) vs large (>2 cm).1