Kaisu Posted December 27, 2007 Share Posted December 27, 2007 I've had several spontaneous pneumos present in the ED.. young (not 45 yr old) males - tall and thin.. BUT - they usually only drop one lung and can tolerate it very well. They relate a history of activity (basketball, one guy was bending over to pick stuff up, etc.) followed by a sharp pain. A bilateral pneumo in a middle aged fellow is pretty much a zebra IMHO. My instructor told me that we were expected to recognize the common stuff.. that there was no way of knowing every wierd thing that was out there... I don't know if I've said it but I sure as heck have thought it - your preceptor is an anal orafice... Don't let her get to you. Link to comment Share on other sites More sharing options...
NREMT-Basic Posted December 27, 2007 Share Posted December 27, 2007 Also, I would recommend a new instructor. Next class ask him what the total down time was before decompress because if it was as long as your scenario would indicate, he may be more alive but will be living in the produce section. Link to comment Share on other sites More sharing options...
DwayneEMTP Posted December 27, 2007 Author Share Posted December 27, 2007 Also, I would recommend a new instructor. Next class ask him what the total down time was before decompress because if it was as long as your scenario would indicate, he may be more alive but will be living in the produce section. I'm not sure I get what you're saying NRB...If the down time is too long then don't decompress? Dwayne Link to comment Share on other sites More sharing options...
Mateo_1387 Posted December 27, 2007 Share Posted December 27, 2007 You notice (The medic says this should have been one of my first questions) that the patient is thin, and approx 6'6” tall.... This should have been noted in the general impression. Tachy @ 176. Unknown BP though pulse is strong and full I don't understand how the man can have a tension pneumo (especially a bilat. one) and still have a strong and full pulse while not moving air. If he is not getting enough air and its compressing his heart I'd expect signs and symptoms of shock, To me this would be some signs found early...... thats just my thinking... I enjoyed following/participating in the scenario Link to comment Share on other sites More sharing options...
DwayneEMTP Posted December 27, 2007 Author Share Posted December 27, 2007 I'm not sure how soon you'd see cardiac effects from a pneumo, if ever, assuming we're talking pressure and not hypoxia of course. The lungs aren't really so much crushed, as made unable to inflate. The heart is working by a completely different set of physical principles. Link to comment Share on other sites More sharing options...
Mateo_1387 Posted December 28, 2007 Share Posted December 28, 2007 I'm not sure how soon you'd see cardiac effects from a pneumo, if ever, assuming we're talking pressure and not hypoxia of course. The lungs aren't really so much crushed, as made unable to inflate. The heart is working by a completely different set of physical principles. intrathoracic pressure would decrease the cardiac output. Link to comment Share on other sites More sharing options...
Lone Star Posted December 28, 2007 Share Posted December 28, 2007 Does a spontaneous pneumothorax present with the same signs as a tension pneumothorax? I speciffically refer to the trachial deviation from midline, and JVD. Link to comment Share on other sites More sharing options...
mobey Posted December 28, 2007 Share Posted December 28, 2007 Does a spontaneous pneumothorax present with the same signs as a tension pneumothorax? I speciffically refer to the trachial deviation from midline, and JVD. Simple answer....NO You have to consider what causes the deviation and JVD. Increasing interthoracic pressure on one side pushes the mediastinum to the opposite side. The same can be said for the JVD. Think about what causes Jugular veins to distend? How can a pneumo cause this? Simple Pneumothorax S&S include chest pain, Dyspnea, Anxiety As it progresses you will find hyperextension of the chest wall, decreased air entry on one side, Cyanosis, Trending decrease in BP, percussion tone changes between the 2 sides. Tension Pneumo will show further hypotension, JVD, Mental status change,Pulsus Paradoxus, abdominal distension, possible deviated trachea toward unaffected side. Remember you have to feel trachea deviation, you cannot see it. You must feel down the trachea as far as you can. I once was involved with a trauma victim that was deceased from other injuries, his chest X-Ray showed huge mediastinum shift but you could not even feel tracheal deviation although you could see it on the x-ray. Link to comment Share on other sites More sharing options...
litteratissimus_medic Posted December 28, 2007 Share Posted December 28, 2007 Nice scenario and responses. Just for the record it's intrathoracic not interthoracic. Intra is a Latin preposition meaning "within" while inter means "between". Link to comment Share on other sites More sharing options...
zzyzx Posted December 30, 2007 Share Posted December 30, 2007 Dude, your preceptor is an idiot. She really scares me. Link to comment Share on other sites More sharing options...
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