Tension pneumothorax

A **tension pneumothorax** is when air builds up inside the chest. So much air builds up that one or both lungs may . This causes serious breathing problems. Also, the air in the chest pushes on the heart and other important parts of the body, and causes other serious problems. One example is the blood vessels supplying the heart collapsing, leading to heart failureand death. 

Without chest decompression in a patient, if there is haemodynamic instability (blood oxygen/carbon dioxide, blood pressure) or severe respiratory problems, pneumothorax will kill a person. It causes a type of shock and is a serious, life threatening comdition.

## How does a tension pneumothorax happen?
A tension pneumothorax usually happens because of an injury to the chest. For example, a knife or gunshot wound will cause a hole in a person's chest. Air then gets sucked in through that hole. The air starts to build up. It pushes on the lungs.  If the knife or gun has also caused a hole in the person's lung, air will leak out of the lung. That air will also build up in the chest. When enough air is pushing on the lung, the lung will collapse.

Pressure in the chest can also squeeze the vena cavae, the big veins that bring blood from the body back to the heart. If the vena cavae are squeezed too tightly, blood will not be able to get into the heart. This means the heart will not have enough blood to pump to the lungs or the rest of the body.
* *Mediastinal shift*. This means that everything in the mediastinum - the space between the heart and the lungs - will get pushed to one side by the air or blood in the chest. For example, a medical professional will be able to see that the trachea (windpipe) is pushed to one side. In medicine, this is called *tracheal deviation* or *tracheal shift*.
* *Jugular vein distention (JVD)*. This means that the big veins in the neck will be filled with blood. They will look big and full. This happens because blood cannot get to the heart through the vena cavae, because they are being squeezed too hard, so the blood backs up into the veins in the neck (the jugular veins).
* *Bulging intercostals*. The muscles between the ribs may get pushed out because of the pressure inside the chest.
* *Unilateral breath sounds*. When a medical professional listens to the lungs with a stethoscope, they will be able to hear breath sounds - the sounds of air going in and out of the lungs - only on one side. They will hear nothing on the side where the lung has collapsed.

## Treatment
A tension pneumothorax needs emergency medical treatment. If a person may have a tension pneumothorax (or has any bad injury to the chest), 911 or another emergency telephone number should be called right away. The emergency medical dispatcher will be able to explain how to help the person until an ambulance gets there.

Emergency medical technicians (EMTs) or paramedics may give these treatments for a tension pneumothorax:
* Give the person oxygen
* Put something *occlusive* over the hole in the chest to keep air from getting through. Examples of things that can be put over chest wounds are plastic wrap, aluminum foil, a hand with a medical glove on it, or special sticky plastic bandages (called *occlusive dressings*). These will keep more air from getting in through the hole in the chest. They also keep even more pressure from building up in the chest.
* Put a hollow needle into the person's chest so air can get out through the needle. This is called a *needle decompression*.

At the hospital, a patient with a tension pneumothorax will be given a chest tube. This is a tube that is placed into the chest so that air or blood can get out and does not build up inside. If the person has bled a lot into their chest, they may also get blood transfusions.

## Related pages
* Pneumothorax
* Lungs

## References