Witnessed tension pneumothorax | Figure 1

MatthewEMS

EMT

Witnessed tension pneumothorax

EMS called to a 45yoF stabbed and finds the patient seated, distressed, tachypneic with a single stab wound superior to L clavicle with slight JVD visible and c/o SOB and chest pain.

Initial VS: RR44, HR 120, SpO2 76% (Room air), BP 115/74. 3 way dressing, NRB Oxygen.

On loading into ambulance RR ↑ to 60, very distressed, ↑ JVD, SpO2 ↓ 60%.

Needle thoracentesis with 14G performed, immediate relief with RR decreasing, SpO2 ↑ to 90%.

IV access TKVO, pre-alert trauma centre, rapid transport. Stable en-route.

Significant swelling to L chest, with increasing subQ emphysema.

On follow up patient had Left haemopneumo and right sided pneumo. Thoughts on the mechanism for the right sided pneumo?

Similar cases

49 y/o male. C/C is chest pain, right shoulder pain, nausea.\
Patient is poor historian.\
Patient is found to be wearing a defibrillation band around his chest.\
JVD present. Distended abdomen. Lower extremities have severe pitting edema.\
BP 92/65. Pulse 98-105. RR 18. Spo2 99% RA.\
Looking for assistance in breaking down this 12 lead, as well as treatment plans.

72YOM, Chief complaint of chest pain and dyspnea. Sudden onset. Vital signs: BP 146/82 HR 86 RR 26 SpO2 82%RA up to 96% 15lpm NRB. What is going on in this chest xray? treatment? Further information? STUDENTS PLEASE

This young gentleman presented to us following an assault. Unsure of the exact mechanism of injury as he was found on the side of the road. Of note he had two 2cm stabs to the front of the chest. One on the right at 5th intercostal space midclavicular line, the other was 4th intercostal space parasternal. The X-ray was done on admission. Can anyone see the pathology? Answers to follow

After two chest tubes inserted and blood O-ve is going, X-ray is as shown. Vital signs : BP= 99/55 mmHg HR=111bpm spo2=80%-90%. Surgery people want to take patient for CT. But suddenly patient's spo2 started to go down again to 60%. By re-examining patient chest he started to have swelling around the chest tube and left clavicle with crepitations on palpation (surgical Emphysem). Surgery want to hace patient's CT done. What is the best next to be done?

Trending now

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis.\
He had a history of hypertension, long-term smoking, and a sedentary lifestyle.\
On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets.\
Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this ekg that would warrant further work-up or is this just a pediatric ekg?