This patient is a 16 year old male who presents to the emergency department status post stab wound to the right chest. The following radiograph was taken.

Questions:

1. Describe what you see? Portable CXR which shows collapse of the right lung with mediastinial shift to the left.

   Diagnosis: Tension Pneumothorax

2. What signs and symptoms would this patient present with?

· Chest pain (90%)

· Dyspnea (80%)

· Anxiety

· Fatigue

3. What would you find on physical exam?

· Respiratory distress and/or arrest

· Cyanosis

· Unilaterally decreased or absent lung sounds

· Lung sounds transmitted from the nonaffected hemithorax are minimal with auscultation at the midaxillary line

· Tachypnea

· Hyperresonance of the chest wall on percussion

· Increasing resistance to providing adequate ventilation assistance

· Tachycardia

· Tracheal deviation (relatively late finding due to midline shift with a tension pneumothorax)

· Jugular venous distension (with a tension pneumothorax)

· Hypotension (key sign of a tension pneumothorax)

· Pulsus paradoxus

· Mental status changes, including decreased alertness and/or consciousness

4. How would you manage this patient?     

· Immediately perform needle thoracostomy or chest tube placement. Once a needle thoracostomy has been performed, chest tube insertion must follow.

· If a hemothorax is associated with the pneumothorax, additional chest tubes may be needed to assist drainage of blood and clots. If the hemopneumothorax requires insertion of a second chest tube, the second tube should be directed inferiorly and should be posterior to the diaphragm.

Trivia:  Who was the Beatles' drummer before Ringo Starr?

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