scenario015

The deterioration in the CT scanner is due to the development of a right sided tension pneumothorax, despite the presence of a chest tube. A posteriorly placed chest drain may become compressed and blocked by lung tissue during the tensioning process.

Drains should be placed anteriorly whenever possible. Haemothoraces will still be drained adequately provided the lung is able to expand.

Although cardiac tamponade would also produce shock and low-reading oxygen saturations due to poor perfusion, high airway pressures are not associated with tamponade.

The raised central venous pressure makes the diagnosis of haemorrhagic shock unlikely. However CVP readings in isolation should be interpreted with caution.