Tension what?

Tension pneumothorax is a not-uncommon and much feared complication of major trauma.  Anyone who looks after trauma patients in the course of their clinical practice must consider the possibility of a tension pneumothorax in all patients with shock or respiratory distress and actively seek to rule it out or treat it.

I’d hope that we all think of tension pneumothorax in these situations, and given the increasing ubiquity of ultrasound as an extension of clinical examination it is becoming easier to rule it out.

Recently I saw a condition that, to be honest, I had previously doubted the existence of. A tension haemothorax.  Presented just like its airy cousin, but with blood instead of air.  Near instant improvement in circulation and ventilation once drained.

There isn’t much written about tension haemothorax, just case reports really.  So it’s pretty rare.  But it was a lesson for me that you always need to consider a secondary cause of shock, particularly an obstructive cause in a patient who’s response to treatment isn’t going as expected.  So I just wanted to write a short post telling everyone that tension haemothorax really exists.

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