After two chest tubes inserted and blood O-ve is going, X-ra | Figure 1

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 have patient's CT done. What is the best next to be done?

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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](https://app.figure1.com/case-detail/30715263-08b8-4af2-ab03-ab5fc3f10182)



Ventilated patient came in from NH for pneumothorax due to barotrauma. No clinical signs of JVD or tracheal deviation and stable vitals. Tension pneumo found on CXR. I seem to remember a very old video about chest tubes and that one of the first signs of a tension is a completely motionless chest on the side of the pneumo (which in hindsight the patient had). Patient was stable so we went right for a chest tube and saved the day.](https://app.figure1.com/case-detail/6f6b7363-b931-4d0c-a56c-c6826272268c)



fell off a ladder. GCS 15. SaO2 92% Should never have been taken to CT without chest drains. Unfortunately clinical exam with extensive subcut emphysema and reduced breath sounds ignored based on SUPINE CXR which appeared to show reasonably inflated lungs (and extensive emphysema). Pt dropped BP in CT rushed back and tubes inserted. He's fine now.](https://app.figure1.com/case-detail/725b74bb-ff96-4364-932f-39d04e8af5d1)



CXR and CT of same patient. What's going on and what would you do next?](https://app.figure1.com/case-detail/809bfc02-8153-4ac2-a056-7d2b6e72928a)

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