Chart — Respiratory
Pneumothorax Types Comparison Chart
The one that must not be missed is tension — tracheal deviation, JVD, and hypotension mean needle decompression now, before any x-ray. The others differ by cause and the right first move.
Educational use only. Tension pneumothorax is a life-threatening emergency. Treatment is provider-directed. This chart is an educational comparison aid. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
The Four Types
| Type | Cause | Key findings | First action |
|---|---|---|---|
| Simple / spontaneous | Bleb rupture (tall thin young men), procedures | Sudden pleuritic pain, dyspnea, ↓ breath sounds, hyperresonance | Observe if small; chest tube if larger |
| Tension | One-way valve traps air → pressure builds, mediastinum shifts | Tracheal deviation AWAY, JVD, hypotension, absent breath sounds, severe distress | IMMEDIATE needle decompression (2nd ICS, midclavicular) → chest tube |
| Open ('sucking') | Penetrating chest-wall defect | Air movement through wound, dyspnea | Occlusive dressing taped on THREE sides (flutter valve) → chest tube |
| Hemothorax | Blood in the pleural space (trauma, vessel injury) | ↓ breath sounds, DULLNESS to percussion, signs of hypovolemia | Chest tube; monitor blood output and hemodynamics; transfuse as needed |
Exam Traps
- ✦Tension pneumothorax: tracheal deviation AWAY + JVD + hypotension + absent breath sounds → immediate needle decompression (don't wait for x-ray).
- ✦Open chest wound: occlusive dressing taped on THREE sides (lets air out, not in).
- ✦Pneumothorax = hyperresonant percussion; hemothorax = dull percussion.
- ✦All have decreased/absent breath sounds and decreased expansion on the affected side.
- ✦Hemothorax: watch chest-tube blood output and for hypovolemic shock.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with American Association for Respiratory Care (AARC) · GOLD (COPD) / ATS / CHEST. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →