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Tension pneumothorax under anaesthesia — FRCA Final MCQ

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ModerateTrauma and Emergency AnaesthesiaTension pneumothorax under anaesthesiaFRCA Final

A 35-year-old man is anaesthetised for emergency laparotomy after penetrating chest trauma. Shortly after positive pressure ventilation starts, SpO2 falls to 82%, systolic blood pressure is 60 mmHg, airway pressure is high, and the right hemithorax is silent with tracheal deviation left. What is the most likely cause of the complication?

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Correct answer: A — Tension pneumothorax precipitated by positive pressure ventilation

Hypotension, hypoxaemia, high airway pressure, unilateral absent breath sounds and tracheal deviation after positive pressure ventilation indicate tension pneumothorax. Endobronchial intubation can cause unilateral ventilation but would not usually produce tracheal deviation and shock. Anaphylaxis causes bronchospasm and vasodilation rather than unilateral silent chest. Immediate decompression is required before imaging.

Reference: ATLS guidance; NICE NG39 major trauma