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Tension Pneumothorax 



  • A tension pneumothorax happens when air in the pleural space builds up enough pressure to reduce venous return, resulting in hypotension, tachycardia and severe dyspnea. 

  • Patients receiving mechanical ventilation are more likely to progress to cardiovascular collapse




  • Tachycardia and Hypotension

  • High airway pressure and oxygen desaturation

  • Contralateral shift of the trachea 


  • Notify surgeon and call for help as necessary

  • Apply 100%  oxygen and reduce anesthetic agents

  • Treat hypotension with fluids and pressors as required

  • Decompress the pneumothorax immediately

    • 14G needle  at the 2nd intercostal space in the midclavicular line

    • Definitive management with chest tube insertion by qualified personnel


  1. Bacon AK, Paix AD, Williamson JA, et alCrisis management during anaesthesia: pneumothoraxBMJ Quality & Safety 2005;14:e18.

  2. Elankumaran Paramasivam, MRCP, Andrew Bodenham, FRCA, Air leaks, pneumothorax, and chest drains, Continuing Education in Anaesthesia Critical Care & Pain, Volume 8, Issue 6, December 2008, Pages 204–209


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