Unexpected Fatal Tension Pneumothorax: A Case Report Regarding a Patient With Multiple Traumas on Air Medical Transportation

Published:January 15, 2021DOI:


      A 45-year-old male driver was assessed by the road rescue team after a car crash. He was in shock and had a deep second-degree burn, multiple bone fractures, and chest wounds. After stabilization, he was delivered to the nearest local clinic by an ambulance. The doctor decided to refer him via air transportation due to the lack of sufficient facilities and the urgent need for an intensive care unit after coordination with the nearest hospital and air medical team. A Bell 214C medical helicopter was called, and transfer was initiated after patient preparation by the air medical team. A few minutes later, his clinical condition deteriorated, and because of the suspicion of a tension pneumothorax, needle thoracostomy was performed. Crosswind and frequent helicopter movements interfered with tube thoracostomy, leading the air medical crew's decision to land. After completion of tube thoracostomy and during endotracheal intubation, his heart rhythm converted to bradycardia and then asystole. Unfortunately, despite 30 minutes of cardiopulmonary resuscitation, the patient died. The forensic report stated that a glassy foreign body led to penetrating chest wall injury and left lung perforation, possibly causing the tension pneumothorax, cardiopulmonary arrest, and death.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Air Medical Journal
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Walls RM
        • Hockberger RS
        • Gausche-Hill M
        • et al.
        Rosen's Emergency Medicine Concepts and Clinical Practice.
        Elsevier, Philadelphia, PA2018
        • Dries DJ
        Chest trauma: from outside to inside.
        Air Med J. 2020; 39: 157-161
        • Jain A
        • Sekusky AL
        • Burns B
        Penetrating chest trauma.
        StatPearls. StatPearls Publishing, Treasure Island, FL2020 (November 16)
        • Singh AK
        • Ditkofsky NG
        • York JD
        • et al.
        Blast injuries: from improvised explosive device blasts to the Boston Marathon Bombing.
        Radiographics. 2016; 36: 295-307
        • Jarraya M
        • Hayashi D
        • de Villiers RV
        • et al.
        Multimodality imaging of foreign bodies of the musculoskeletal system.
        AJR Am J Roentgenol. 2014; 203: W92-102
        • Tseng HJ
        • Hanna TN
        • Shuaib W
        • et al.
        Imaging foreign bodies: ingested, aspirated, and inserted.
        Ann Emerg Med. 2015; 66: 570-582
        • Beninati W
        • Polk JD
        • Fallon WF
        Civilian air medical transport aeromedical evacuation.
        in: Hurd WW Beninati W Aeromedical Evacuation. 2nd ed. Springer, Charn, Switzerland2019: 41-56