Tension Pneumothorax (Eng/Kor) for NCLEX

Tension Pneumothorax

긴장성 기흉

 Definition 정의

A tension pneumothorax occurs when air enters the pleural space and cannot escape, causing increasing pressure that collapses the affected lung and shifts the mediastinum → compressing the heart and opposite lung.
Life-threatening emergency.

긴장성 기흉은 공기가 흉막강으로 들어가지만 빠져나오지 못해 압력이 계속 증가하여
→ 해당 폐가 완전히 허탈되고
→ 심장과 다른 폐가 밀려나는(종격동 전위)
치명적인 응급상태입니다.

 Causes 원인

• Chest trauma (penetrating or blunt)
  흉부 외상
• Mechanical ventilation with high PEEP
  기계환기(PEEP 높음)
• Rupture of bleb in COPD/asthma
  COPD/천식 환자에서 폐포 파열
• Post–central line insertion
  중심정맥관 삽입 후 합병증
• Lung procedures (biopsy, thoracentesis)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 Clinical Manifestations 임상 증상 (Classic Signs)

Severe respiratory distress + hemodynamic instability

 Life-threatening findings:

• Absent breath sounds on affected side
  해당 측 호흡음 소실
• Tracheal deviation to opposite side
  기관이 반대쪽으로 밀림
• Jugular vein distention (JVD)
  경정맥 팽창
• Hypotension (obstructive shock)
  저혈압
• Tachycardia / tachypnea
  빈맥 / 빈호흡
• Hyperresonance on percussion
  타진 시 과공명음
• Cyanosis (late)
  청색증(늦은 징후)

 Diagnosis 진단

Do NOT wait for imaging if suspected — treat immediately.

의심되면 X-ray 기다리지 않고 즉시 처치해야 함.

Chest X-ray (if patient stable enough):

• Collapsed lung
• Mediastinal shift

 Treatment 치료 (Emergency!)

 

 1. Immediate needle decompression

14–16 gauge needle inserted into:

• 2nd intercostal space, midclavicular line (traditional)
  OR
• 5th intercostal space, anterior axillary line (modern preferred)

→ Releases trapped air and relieves pressure.

바늘 감압술을 즉시 시행하여 압력 해소.

 2. Chest tube insertion (definitive)

After needle decompression:
Chest tube (tube thoracostomy) at 4th–5th ICS, anterior/mid-axillary line.

그 후 흉관 삽입으로 공기 지속적 배출.

 3. Oxygen therapy

고유량 산소 공급

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 Nursing Considerations 간호 중재

• Recognize signs early
  징후 조기 발견
• Call rapid response/MD immediately
  즉시 도움 요청
• Prepare for needle decompression & chest tube
  바늘 감압/흉관 삽입 준비
• Monitor:
  • SpO₂, RR, HR, BP
  • Breath sounds
  • Chest symmetry
• Keep equipment ready:
  14G needle, chest tube tray
• Post-procedure:
  • Monitor for recurrence
  • Assess for subcutaneous emphysema
  • Maintain chest tube drainage system

 Patient Teaching (after stabilization) 환자 교육

• Avoid high-pressure ventilation settings
  높은 압력 환기 피하기
• Avoid smoking
  금연
• Report sudden chest pain or dyspnea immediately
  갑작스러운 흉통/호흡곤란 시 즉각 알리기
• Follow-up imaging regularly
  정기적인 흉부 영상 검사