A 26 yo is brought in by ambulance to the ER. EMS states that she was an unrestr
ID: 3509009 • Letter: A
Question
A 26 yo is brought in by ambulance to the ER. EMS states that she was an unrestrained passenger in a head-on collision, and was ejected from the vehicle. She is unconscious and receiving positive pressure ventilation (with supplemental oxygen), as she cannot breathe on her own. On exam, you can hear lung sounds on her right chest, but not on her left; you also note that her left chest is tympanic, and that the inferior end of her trachea is displaced to the right. Multiple bruises and abrasions cover her body.
What is this patient’s likely diagnosis?
Severe asthma
Pneumothorax (air in the pleural space)
Hemothorax (blood in the pleural space)
Flail chest
Why is her trachea deviated to the right?
On X-ray, how do you expect the left side of her chest to look, compared to the right side of her chest? (darker / lighter)
What type of treatment should this patient receive? (INDICTE ALL THAT APPLY)
Removal of air trapped in the chest, to allow the lung to reexpand
Removal of blood trapped in the chest, to allow the lung to reexpand
Peeling away of the parietal pleura, to prevent reoccurrence of this condition
Sandbags against the affected part of the chest
Explanation / Answer
The patients likely diagnosis is Pneumothorax.
As the pressure on left side of a lung has increased the trachea has shifted to the right because shift always occurs on the opposite side of the increased pressure.
The left side of a chest will look lighter as compared to the right one.
For treatment there should be removal of air which is trapped in the chest so that the lungs can re expand, by removing the air the pressure will decrease and the trachea will move to its normal position.
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