References
Tension pneumothorax: are prehospital guidelines safe and what are the alternatives?
Abstract
Tension pneumothorax is a life-threatening complication of chest injury. It can cause rapid physiological decompensation, cardiac arrest and death. The Joint Royal Colleges Ambulance Liason Committee (JRCALC) provide guidelines on the prehospital diagnosis and treatment of this condition. The aim of this article is to ask whether or not these guidelines are effective and if there are feasible alternatives to the management of tension pneumothoraces in the prehospital environment.
This article discusses recent literature regarding the prehospital treatment of tension pneumothorax. The obstacles involved in diagnosing the condition are considered, along with the techniques to treat it. Is current paramedic practice in dealing with the condition providing safe and effective care for patients and are there feasible prehospital alternatives?
Tension pneumothorax (TPNX) is an immediately life-threatening thoracic injury (Leigh-Smith and Davies, 2003). It occurs when a one way valve is created between the lung and the pleura. This leads to a build up of air in the pleural cavity during each respiratory cycle resulting in an increase in intrathoracic pressure.
Eventually the lung on the injured side collapses and the mediastinum is displaced towards the opposite side. Venous return is compromized and cardiac arrest can follow (Watts and Howell, 2001).
The JRCALC (2006) guidelines emphasize the possible need for rapid therapeutic action, with Leigh-Smith and Davies (2003) in agreement that if the clinical signs suggest a TPNX, then rapid treatment is required.
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