EMCrit Podcast EMCrit Podcast 245 – Tension Pneumothorax with Simon Leigh-Smith
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Apr 26, 2019 In this episode, guest Simon Leigh-Smith, an emergency medicine consultant with military expertise, dives deep into the complexities of tension pneumothorax. He reveals that it encompasses two distinct diseases based on patient ventilation status. Simon shares a pivotal 2002 case that shifted his perspective and outlines a three-step diagnostic process. He emphasizes the importance of rapid decision-making for decompression and discusses how classic signs can mislead clinicians. The conversation is packed with clinical insights and the latest treatment strategies!
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Tension Pneumothorax Is Two Diseases
- Tension pneumothorax is actually two distinct diseases: mechanically ventilated and spontaneously breathing patients.
- Their physiology, presentation, and management differ markedly and should not be conflated.
14-Year-Old Case Sparked The Inquiry
- Simon described a 14-year-old with post-fall cyanosis who improved stepwise with needle, finger, then chest tube decompression.
- The case sparked his deep review and research into tension pneumothorax.
Don't Rely On Tracheal Deviation
- Discard reliance on tracheal deviation as a rule-out for tension pneumothorax.
- Do not assume absence of deviation excludes the diagnosis.