The diagnosis of tension pneumothorax should be made on clin¬ical examination. The classic findings include respiratory distress (in an awake patient), hypotension, diminished breath sounds over one hemithorax, hyperresonance to percussion, jugular venous dis¬tention, and shift of mediastinal structures to the unaffected side with tracheal deviation. In most instances, empiric treatment with pleural decompression is indicated rather than delaying to wait for radiographic confimnation. When a chest tube cannot be immedi¬ately inserted, such as in the prehospital setting, the pleural space can be decompressed with a large caliber needle. Immediate return of air should be encountered with rapid resolution of hypotension. Unfortunately, not all of the clinical manifestations of tension pneu¬mothorax may be evident on physical exam. The use of medical microscopes such as a battery powered microscope in the diagnosis and treatment of cardio-respiratory diseases are prevalent today. (more…)