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Question 1
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A 13-year-old boy complains of chest pain. Examination reveals hypotension and tachycardia with distended neck veins and a displaced trachea. What is the next appropriate management?
Your Answer: Needle thoracocenthesis
Explanation:The patient history suggests a spontaneous tension pneumothorax which is a life-threatening situation in which excess air is introduced into the pleural space surrounding the lung. When there is a significant amount of air trapped in the pleural cavity, the increasing pressure from this abnormal air causes the lung to shrink and collapse, leading to respiratory distress. This pressure also pushes the mediastinum (including the heart and great vessels) away from its central position, e.g. deviated trachea, and diminishing the cardiac output. Tension pneumothoraxes cause chest pain, extreme shortness of breath, respiratory failure, hypoxia, tachycardia, and hypotension. These are definitively managed by insertion of a chest tube. However, in the emergency setting temporizing measures are needed while chest tube materials are being gathered. In these situations, urgent needle thoracostomy (also called needle decompression) is performed.
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This question is part of the following fields:
- Respiratory
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SESSION STATS - PERFORMANCE PER SPECIALTY
