Tension Pneumothorax – does it really occur that often?
• Timothy C Hardcastle, Trauma Surgeon University of Stellenbosch, Tyberberg Hospital, Cape Town, RSA Dear Editor, I write regarding the review published in the EMJ [1], a photocopy of which was presented to me by a student paramedic to comment on. I take this opportunity to submit a rapid response. You correctly state that the definition of Tension Pneumothorax is difficult to pin down early in your article and that the various definitions contain combinations of various criteria. With this I concur. International ATLS and DSTC consensus currently still require the following: (Commenting on Box 1) 1) Haemodynamic comprimise. 2) Evidence of mediastinal compression – not necessarily SHIFT of trachea, since the effect of air under pressure is to expand, thus exerting more expansile pressure that liquid. 3) Cardiac inability to fill due to this relative compression – which then leads to a raised JVP, which may not necessarily distend the neck veins, but this usually occurs. The question m
