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- car accident
- chest
- contusion
- lung
- lung
- lung
- lung
- lung
- pericardium
- pneumopericardium
- pneumothorax
- tension
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Comments
Luis Pinheiro, Viseu - Portugal, October 12, 2008
Great image, Leonardo! Why a CT was performed in a patient with a tension pneumothorax? Not infrequently they occur in the radiology suite… otherwise a decompression needle or chest tube should already be in place! Agree?
Hassegawa, L, February 22, 2009
Luis Pinheiro,
You are absolutey right. This patient was mismanaged possibly due to a overloaded ER. However, I know that no excuse is good enough.
This patient was brought 15 minutes after the accident.
A: GCS 4. He was being promptly intubated
B: Dispite crackles in both hemithoraxes, both lungs were ventilating well
C: Pulse: about 140; BP 80/50 mmHg (It raised to 120/80 after RL 1000 mL)
D: GCS 4. Mydriasis
A chest X-Ray was requested. This patient had not been reevalueted in following 20 minutes, when we noticed that the X-Ray was not available (better-prognostic patients). Then a CT scan was requested.
Acctually, when the CT was being performed, the patient was pulseless (notice the cardiac blur absence).
As I wrote, no excuse is good enough.
Post Scriptum: Pardon my rusty English.
Luis Pinheiro, Viseu - Portugal, February 22, 2009
Thanks for the explanation, Leonardo. The patient could sustain the tension pneunothorax after the intubation and ventilation with positive pressure… Prophilactic chest tubes in such cases? Yes or no? I think this is a good point for discusssion.
racostinea, March 06, 2009
indeed a good point; many patients like this one are at high risk of haemorrage from the perrifery of the lungs, aggravated also by inadequate mechanical ventilation. I still do not understand why the patient was taken to the CT scan. Was it to perform a Brain scan or there was no ultrasonografy available to asses the abdomen? What was the prehospital management in this case? It is important to know, as well as the other elements of the proimary assesement in the ER (head trauma, limb fractures and so on…). With crackles, relatively low BP and GCS 4, I think chest tubes are a good option.
