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Ch. 37: Disorders of Ventilation and Gas Exchange

Terms in this set (79)

Clinical Manifestations:
• Tachycardia
• Hypotension
• Distended neck veins
• Tracheal shift
- Mediastinal shift/Trachea not midline

• Immediate decompression of lung by insertion of chest tube

IE: stab wound, GSW

all air accumulating rapidly in pleural space, ticking time bomb, needs immediate decompression

chest tube reestablishes pressure

"Tension pneumothorax is the progressive build-up of air within the pleural space, usually due to a lung laceration which allows air to escape into the pleural space but not to return. Positive pressure ventilation may exacerbate this 'one-way-valve' effect.

Progressive build-up of pressure in the pleural space pushes the mediastinum to the opposite hemithorax, and obstructs venous return to the heart. This leads to circulatory instability and may result in traumatic arrest. The classic signs of a tension pneumothorax are deviation of the trachea away from the side with the tension, a hyper-expanded chest, an increased percussion note and a hyper-expanded chest that moves little with respiration. The central venous pressure is usually raised, but will be normal or low in hypovolaemic states.

However these classic signs are usually absent and more commonly the patient is tachycardic and tachypnoeic, and may be hypoxic. These signs are followed by circulatory collapse with hypotension and subsequent traumatic arrest with pulseless electrical activity (PEA). Breath sounds and percussion note may be very difficult to appreciate and misleading in the trauma room." (