Acute severe asthma complicated with tension pneumothorax and hemopneumothorax

A 47-year-old patient presented to the emergency room with an attack of acute severe asthma. In spite of all primary measures, the patient was deteriorating. Arterial blood gases showed hypercarbia and acidemia. The patient was shifted to the intensive care unit connected to noninvasive ventilation for 3 h, without any obvious improvement. Decision was taken to intubate, ventilate, and keep her deeply sedated. On the 4^th day of ventilation, the patient developed sudden tension pneumothorax and she was near to arrest. Management for tension pneumothorax was immediate and successful. After that, chest X-ray and computerized tomography scan showed hemopneumothorax, for which a chest tube was inserted in both chest sides and blood transfusion was initiated immediately. After this incidence, the patient's parameters improved dramatically. Four days later, the patient was extubated and kept in intensive care unit till the chest tubes were removed and then shifted to the ward and discharged on day 15 from admission.