What is the primary symptom of a tension pneumothorax?

The primary symptom of a tension pneumothorax is characterized by severe respiratory distress and hypotension. This condition arises when air becomes trapped in the pleural space and increases thoracic pressure, which can severely compromise respiratory function and cardiovascular stability. The trapped air displaces mediastinal structures, leading to impaired venous return and reduced cardiac output, resulting in hypotension.

Patients experiencing tension pneumothorax often display acute respiratory failure due to decreased lung capacity, which manifests as severe shortness of breath, tachypnea, and perhaps cyanosis. The combination of these symptoms reflects the urgency of the situation and the need for immediate intervention to relieve the pressure in the pleural space, typically through needle decompression and subsequent chest tube placement.

While chest pain, fever and chills, and subcutaneous emphysema can be associated with other thoracic conditions, they do not encapsulate the critical nature of the presentation seen in tension pneumothorax, where circulatory and respiratory compromise dominate the clinical picture.