EMS Pneumothorax Identification Without Ancillary Testing

Excerpt

Prehospital providers are responsible for identifying and treating various conditions that may need rapid intervention. Pneumothorax is one potentially life-threatening condition that may be quickly identified with high-quality physical examination skills. The condition develops when air accumulates in the pleural space, causing partial or complete lung collapse. Continuous air accumulation can increase intrathoracic pressure. Tension pneumothorax arises when intrathoracic air pressure is high enough to shift mediastinal contents contralaterally. Up to 1 in 20 major trauma patients develop tension pneumothorax. Treating pneumothorax can be relatively simple, though complications like cardiac or major blood vessel injury can occur.

Identifying this condition in the prehospital setting is challenging. Unlike the resource-rich emergency department, prehospital providers cannot rely on imaging studies or thoracic surgery consultation when evaluating individuals with a possible pneumothorax (see Image. Left Pneumothorax on X-ray). Additionally, comorbid conditions like chronic obstructive pulmonary disease (COPD), asthma, congestive heart failure, and pleural effusion can mimic a pneumothorax clinically. Understanding the nuances in the clinical presentation of this condition can improve prehospital diagnostic accuracy and time to initial intervention.