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.
2 case question available
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 the clinician is based on the maximal pleural separation from the chest wall: small (< 2 cm) vs large (>2 cm) 1.