A 20-year-old female asthmatic arrives by ambulance complaining of sudden onset of breathlessness and right sided pleuritic pain. She has had pneumothoraces on the right side in the past and has had video assisted thorascopic surgery (VATS) to prevent further episodes. The following is seen:
There is reduced air entry on the right side compared to the left but you can hear no crackles or wheeze. The trachea is central, there is no neck vein distension and heart sounds are normal. You administer high-flow oxygen and move the patient to the resuscitation room for a chest x-ray.
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True or false: This could be a tension pneumothorax.
This could be a tension pneumothorax.
What should you do?
The chest radiograph (shown right) confirms that this is a tension pneumothorax (increased rib spaces and flattened hemi-diaphragm). There is also subtle mediastinal shift but no tracheal deviation. Her condition remains stable.
What should you do next?
The drain kits in Resus have not been re-stocked and as the nurse goes to get a kit the patients BP drops and she becomes less responsive. Now what should you do?
You perform needle decompression with a 14g cannula in the 2nd intercostal space but hear no hiss. The patient’s condition continues to deteriorate.
At this stage you should: