Tracheal Shift and Spontaneous Pneumothorax

[Just Plain Ruff]

your guest instructor is a maroon and an Id10t

What other blatant falsehoods have they told you?

[Medic2588]

Apparently all you need to be considered an expert is an audience! :roll:

It might be rare that you see trach deviation, but it can happen. Its a late sign or a sign of a SERIOUS injury, but you will see it eventually. Some maybe more than others, but you most likely see it.

Devin

[ERDoc]

Please have your instructor join this site ! I would love to hear their explanation of why one can not determine pnuemothorax in the field.. oh, they are F.O.S. .. ask what that medical abbreviation is. :wink: They are right about tracheal deviation it is a late sign as others has posts.. remember it takes a lot of movement to shift the lung, heart, mediastianum to cause tracheal deviation...

Here is a pic that a Flight nurse has that shows a major pnuemo..please not the shift on the film at the trachea level...

guess what gang the patient denied of any complaints ....

:shock: DIDN"T COMPLAIN OF ANYTHING!!!!???? :shock:

OK Rid, what't the story on that one?

[Ridryder 911]

You can see the original posts at WWW.Defrance.com Sorry, should had stated no distress...Which was shocking to me !

"Randy Moulin RN, CFRN in Louisville, Kentucky Randy stated the patient was A & O x 4 and was in no acute distress. The patient had been D/C'd from the hospital several days prior after recovering from multiple stab wounds".

Be safe, R/R 911

[retired_medic61]

Most are treated before they get to the late late sign of tracheal deviation. Your instructor no doubt has ever seen a tracheal deviation.

[retired_medic61]

Most are treated before they get to the late late sign of tracheal deviation. Your instructor no doubt has ever seen a tracheal deviation.

I met never instead of ever on my last post. Sorry, I guess I had my head where the sun does not shine.

[retired_medic61]

Most are treated before they get to the late late sign of tracheal deviation. Your instructor no doubt has ever seen a tracheal deviation.

:shock: Sorry, I meant never instead of ever on my last post.

[Asysin2leads]

From what I've heard and seen, the only way you can really tell a pneumothorax in the field is by unequal breath sounds (and how hard is it to hear sometimes?), dyspnea, and mechanism of injury. Tracheal shift, according to my sources, is usually something found on a post mortem. Have fun popping those chests.

[srs911]

I don't think that the issue is will there be tracheal deviation in a tension pneumothorax... there will be. I think the more important question is "Is the tracheal deviation that accompanies a tension pneumothorax easy to identify on physical exam?" The answer to that, in my opinion, is no, and the pic of the very impressive tension pneumo that is accompanying this thread shows why. Take a look, no doubt there is tracheal deviation. But look above, say, the sternum, and the trachea isn't all that deviated from center. It is, a little, but not all that much, and we're looking an x-ray. Throw a bunch of adipose tissue over that neck and you might agree that it would be difficult to identify... not impossible, just not very obvious as many people think. I know some will say that you can palpate the trachea to see if it's midline, but agian, if it's not all that far off I don't know how easy it will be. And don't forget that this is about as bad as it gets (though you wouldn’t believe it by the description of the patient... unreal!), do you think that it will be easy to identify tracheal deviation on an emerging tension pneumo? Again, my opinion is no. So, while tracheal deviation certainly looks impressive on x-ray, CT, whatever, I think that we should concentrate on other clinical signs and symptoms to aid in our identification of the problem:

MOI (trauma), history (bronchorestrictive disease), or body type (tall thin male with pack o' Camels).

Worsening tachypnea, tachycardia, and hypotension leading to respiratory and cardiac arrest.

Decreasing SpO2.

Diminishing then absent lungs sounds on the effected side, maybe diminished on the opposite as well.

Tympany to percussion on the effected side.

JVD, if the patient isn't hypovolemic.

If you see tracheal deviation, great!

Did I miss anything?

Again, I'm not saying that tracheal deviation doesn't occur, my argument is that we, as EMTs, medics, and especially educators, should place more emphasis on all the other indications and not get hung up on tracheal deviation.

Anyway, that's my 0.02, based on my anecdotal experience, nothing based on science. Take it for what it's worth.

[kevkei]

It's not that difficult to observe trachial deviation. Place your index and middl finger on either side of the trachea in the clavicular notch, what was once unnoticable now should become obvious. Compare the proximal aspect of the trachea as it leaves the jaw line with the distal aspect where it enters the thorax, normally it should be fairly straight.

Another trick is to use a pen and draw a verticle line (from inferior to superior) on the midline of the trachea and do the same on the clavicular notch. If they don't line up, you have shift, or, if it isn't present you have a baseline and in the event they don't align in the future, you have evidence of shifting.