What physical exam findings suggest tension pneumothorax?

The physical exam findings that suggest tension pneumothorax include unilateral absent breath sounds and tracheal deviation. In tension pneumothorax, air becomes trapped in the pleural space and creates increasing pressure that collapses the lung on the affected side. This results in absent or diminished breath sounds on the affected side during auscultation due to the lung being unable to expand properly.

Additionally, as the pressure builds, it pushes the mediastinum and the trachea away from the affected side, leading to tracheal deviation. This deviated trachea is typically directed toward the opposite side of the pneumothorax. The combination of these findings—absence of breath sounds on one side and tracheal deviation—strongly indicates the presence of tension pneumothorax, a critical condition that requires prompt intervention to relieve the pressure and restore normal breathing mechanics.

In contrast, findings such as bilateral breath sounds, hemothorax, decreased breath sounds with normal tracheal alignment, or increased fremitus with dullness would not specifically indicate tension pneumothorax and suggest other pathologies or conditions that are not critical or may occur under different circumstances.