This review examines the present understanding of tension pneumothorax and produces recommendations for improving the diagnostic and treatment decision process.
Tension pneumothorax (TPT) is an uncommon disease with a malignant course leading to death if untreated. It is most commonly encountered in prehospital trauma care, emergency departments, and intensive care units (ICUs). Resuscitation and trauma courses usually illustrate a patient in extremis and assume that the clinical diagnosis is straightforward and the response to needle chest decompression is rapid and reliable. However, this might not be the case in real life. Texts differ when describing the diagnostic symptoms and signs and there are several case reports of diagnostic difficulty or missed diagnosis because of an absence of “classic” signs. Lack of chest signs along with poor correlation between the signs present and those picked up by experienced physicians have been specifically noted. There have also been multiple reports of ineffective needle decompression with adequate treatment only being achieved with tube thoracostomy.