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Tension pneumothorax is normally associated with trauma,1–3 and ventilated patients.2,4,5 It is a rare diagnosis that should not be missed and may be overlooked in other settings. It may not present with all the “classic” signs leading to a potential delay in treatment.1
While serving on a nuclear submarine a 23 year old sailor presented acutely unwell after exercise. He was an extremely fit sportsman of average height and build who was a smoker with no significant medical history.
He was dyspnoeic, and complaining of sudden left sided pleuritic chest pain. On examination he was sweaty and tachycardic with deteriorating consciousness, becoming rapidly weaker and confused. There was reduced expansion and absent breath sounds on the left side, his trachea was deviated to the right, neck veins were prominent, and apex beat was not palpable. Of note, there was no hyper-resonance on the affected side.
He was placed on high flow oxygen and positioned to maintain …