Tension pneumothorax

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  1. Occurs when a ball and valve mechanism in a bronchopleural fistula permits air to enter but not leave causing pressure within the pleural space to rise above atmospheric pressure with complete collapse of the lung and shift of the mediastinum to the opposite side
  2. Hypoxemia is usually minimal or absent but may be severe along with hypercapnia in a patient with an underlying lung disease
  3. Associated with increased venous pressure but NOT pulsus paradoxus
  4. Treatment: a large gauge needle into the chest followed by a use of a 3 way stopcock that may be inserted either anteriorly or laterally
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