Summary
Definition
History and exam
Key diagnostic factors
- direct trauma to the thorax and neck
- dyspnea
- confusion
- tachypnea
- accessory breathing muscle use
- stridor
- inability to speak
- retraction of intercostal spaces
- cyanosis
- loss of airway/gag reflex
Other diagnostic factors
- anxiety
- headache
- hypoventilation
- cardiac rhythm disturbances
- underlying neuromuscular disorder
- drug use
- seizure
- coma
- asterixis
- papilledema
Risk factors
- cigarette smoking
- young age
- elderly age
- pulmonary infection
- chronic lung disease
- upper airway obstruction
- lower airway obstruction
- alveolar abnormalities
- perfusion abnormalities
- cardiac failure
- peripheral nerve abnormalities
- muscle system abnormalities
- opiate and sedative medications
- toxic fumes and gases
- traumatic spinal injury
- traumatic thoracic injury
- central nervous system (CNS) disorders
- acute vascular occlusion
- pulmonary effusion
- pneumothorax
- hypercoagulable states
Diagnostic investigations
Investigations to consider
- CBC
- D-dimer
- serum bicarbonate (HCO3)
- ECG
- CXR
- pulmonary function tests
- Urine or serum toxicology
- chest CT
- CT pulmonary angiography (CTPA)
- ventilation/perfusion lung scan
- capnometry
- cardiothoracic ultrasound
Treatment algorithm
Contributors
Authors VIEW ALL
Professor
Fielding School of Public Health
David Geffen School of Medicine at UCLA
Los Angeles
Deputy Health Officer
Orange County Health Care Agency
Health Disaster Management/Emergency Medical Services
Santa Ana
CA
Disclosures
SJS declares that he has no competing interests.
Peer reviewers VIEW ALL
Consultant Physician
Barts Health
London
UK
Disclosures
CMR declares that he has no competing interests.
University of California
Irvine and Orange County Fire Authority
Irvine
CA
Disclosures
KM declares that he has no competing interests.
Assistant Professor of Clinical Emergency Medicine
Department of Emergency Medicine
University of California
Irvine and Orange County Fire Authority
Irvine
CA
Disclosures
CK declares that he has no competing interests.
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