Just Plain Ruff Posted May 26, 2011 Share Posted May 26, 2011 (edited) Isit just me or did this guys heart outline get larger post intubation? Are we dealing with some sort of mass making ventillation of one side to preclude the other from rising? Or is that 2nd image taken at a different angle. Chest ct would be really nice to have but I just read it was down. The question is this. Did we do more harm than good for this guy by intubating him? I still think I see zebras. I just don't know whether they are white fur with black stripes or black fur with white stripes. Sent from my SPH-D700 using Tapatalk Edited May 26, 2011 by Ruffems Link to comment Share on other sites More sharing options...
ERDoc Posted May 26, 2011 Share Posted May 26, 2011 Hmmm...that's a pretty wide looking mediastinum. Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted May 27, 2011 Share Posted May 27, 2011 So what are the causes of a widened mediastinum? I'm on a plane waiting to leave st louis so I can't do much more than type via tapatalk. Sent from my SPH-D700 using Tapatalk Link to comment Share on other sites More sharing options...
chbare Posted May 27, 2011 Author Share Posted May 27, 2011 Does this help? Appreciate the angle. This patient has physiological tracheal deviation. There are no masses or pathological causes other than the anatomy simply being deviated. Under direct laryngoscopy, you carefully pull the tube back until the cuff is at the cords and the asymmetrical chest rise continues. I will give you guys a hint. A certain physical property of fluids or "effect" is the likely cause. Take care, chbare. Link to comment Share on other sites More sharing options...
Bieber Posted May 27, 2011 Share Posted May 27, 2011 Hmm. Well, the X-ray reminds me of another I've seen in a patient with pericardial effusion, with the widened mediastinum and tracheal deviation, but the heart doesn't look especially bulbous or water-bottle shaped to me. But the flu-like symptoms, and low-grade temperature could be pointing toward pericarditis as well. Maybe exacerbating the guy's preexisting diabetes? I'm not entirely sure. Could the tracheal deviation be kinking one of the bronchi and cause the asymmetrical chest wall motion? I'll come back to this. Time to get ready for work. Link to comment Share on other sites More sharing options...
DwayneEMTP Posted May 27, 2011 Share Posted May 27, 2011 I'm leaning really hard towards his acidotic state causing a fluid shift...it just keeps nagging me but I don't have the info in my brain to make the argument and quick Google searches between other stuff is bearing no fruit...Maybe one of the smart people can look at it from this angle? Dwayne Link to comment Share on other sites More sharing options...
chbare Posted May 28, 2011 Author Share Posted May 28, 2011 Let's say your partner decides to rotate the ETT 90 degrees on it's latitudinal axis. Upon doing this, you note equal, bilateral chest rise and fall. Take care, chbare. Link to comment Share on other sites More sharing options...
Richard B the EMT Posted May 28, 2011 Share Posted May 28, 2011 I don't know what I am looking at on the X Rays. I was going to say investigate for a collapsed lung, but the resumed normal breathing on the rotation of the ETT truly threw me for a loop. Link to comment Share on other sites More sharing options...
rock_shoes Posted May 28, 2011 Share Posted May 28, 2011 Does this help? Appreciate the angle. This patient has physiological tracheal deviation. There are no masses or pathological causes other than the anatomy simply being deviated. Under direct laryngoscopy, you carefully pull the tube back until the cuff is at the cords and the asymmetrical chest rise continues. I will give you guys a hint. A certain physical property of fluids or "effect" is the likely cause. Take care, chbare. ETT Bevel orientation + physiological tracheal deviation = asymetrical chest rise. Sounds almost like the combination is causing the ventilations to "jet" into one lung until that lungs rise in barometric pressure is high enough to force air into the other lung. Rotating the tube removed the directional jet effect allowing equal expansion? Link to comment Share on other sites More sharing options...
chbare Posted May 28, 2011 Author Share Posted May 28, 2011 ETT Bevel orientation + physiological tracheal deviation = asymetrical chest rise. Sounds almost like the combination is causing the ventilations to "jet" into one lung until that lungs rise in barometric pressure is high enough to force air into the other lung. Rotating the tube removed the directional jet effect allowing equal expansion? Very close. Why would this "jet" of fluid be inclined to travel into the right over the left? What is so special about having the distal end of the ETT positioned so close to the tracheal wall as the case is suspected in this patient? Is there a physical principle of fluids that may describe this behaviour? Take care, chbare. Link to comment Share on other sites More sharing options...
Recommended Posts