A 30-year-old female was involved in a head-on motor vehicle collision and presented with a pneumothorax, decreased oxygen saturation, and absent breath sounds on the left side. A chest tube was inserted which initially improved her condition but then showed a return of dark blood. A CT scan revealed a large pericardial effusion and the chest tube tip was near the pulmonary artery. The patient then developed tachycardia, hypotension, and deterioration requiring emergency surgery.
A 30-year-old female was involved in a head-on motor vehicle collision and presented with a pneumothorax, decreased oxygen saturation, and absent breath sounds on the left side. A chest tube was inserted which initially improved her condition but then showed a return of dark blood. A CT scan revealed a large pericardial effusion and the chest tube tip was near the pulmonary artery. The patient then developed tachycardia, hypotension, and deterioration requiring emergency surgery.
A 30-year-old female was involved in a head-on motor vehicle collision and presented with a pneumothorax, decreased oxygen saturation, and absent breath sounds on the left side. A chest tube was inserted which initially improved her condition but then showed a return of dark blood. A CT scan revealed a large pericardial effusion and the chest tube tip was near the pulmonary artery. The patient then developed tachycardia, hypotension, and deterioration requiring emergency surgery.
A 30-year-old female was involved in a head-on motor vehicle collision and presented with a pneumothorax, decreased oxygen saturation, and absent breath sounds on the left side. A chest tube was inserted which initially improved her condition but then showed a return of dark blood. A CT scan revealed a large pericardial effusion and the chest tube tip was near the pulmonary artery. The patient then developed tachycardia, hypotension, and deterioration requiring emergency surgery.
Discussion 04 04-05 November 2020 Case • A 30-year-old female was involved in a motor vehicle accident during a head-on collision with a 16-wheeler truck. Emergency Medical Services arrived within minutes and have noted the following vital signs: BP: 140/90 mmHg, HR: 128 beats/minute. Endotracheal intubation was immediately performed onsite and the patient was transported to the nearest trauma center.
• During transport, the patient was noted to have
decreased 02 saturation of around 80%. The EMT also reported that there was an absence of breath sounds at the left hemithorax. Case
• Upon arrival at the trauma center where you are on-duty,
you suspected a pneumothorax on the left, and have decided to perform decompression, which resulted into the increase of the 02 saturation to 98% and the vital signs stabilizing. However, you have noted that there was a return of dark red blood after performing the decompression using an over-the-needle catheter. Case
• Prior to the formal tube thoracostomy to be performed by
the surgeon, you have decided to request for a chest CT Scan which revealed the following results:
• Large pericardial effusion and fluid in the mediastinum
• The tip of the catheter is in the vicinity of the pulmonary
artery CT scan of the chest showing a large pericardial effusion. Ao, aorta. CT scan of the chest showing the tip of the catheter in the vicinity of the pulmonary artery (PA). Case
• After the CT procedure, the patient developed
tachycardia and hypotension, and her condition rapidly deteriorated. You were then asked to take the patient immediately to the operating theater and to assist the Thoracovascular Surgeon-on-duty. Guide Questions • What are the pertinent features of the case. Describe briefly.
• What are the indications of performing an endotracheal
intubation?. Describe and illustrate how this is performed. Discuss completely the anatomy of the procedure.
• Discuss in detail the anatomy of the a) Thoracic cavity, b)
Lungs, c) Pleura
• Define pneumothorax and hemothorax. Explain its
pathophysiology. Illustrate the difference of the physical examination findings between the two. Guide Questions • Illustrate how an over-the-needle catheter procedure is performed. Discuss the principle behind this procedure in relation to our case.
• How would you explain the return of blood after performing
decompression using the over-the-needle catheter? Discuss thoroughly.
• Discuss in detail the anatomy of the a) heart, b) mediastinum
• Define pericardial effusion. Illustrate and explain its
pathophysiology. Guide Questions
• Explain the chest CT findings. Correlate anatomically.
• Discuss the anatomy of the anterior thoracic wall.
Illustrate how a tube thoracostomy procedure is performed. Explain the principle of behind this procedure.
• The patient developed tachycardia and hypotension, and
her condition rapidly deteriorated. Explain what might have caused this scenario. Guide Questions
• What are the most likely diagnoses? Discuss these
possibilities in detail.
• Discuss the possible complications if this condition is left
New Scientific Basis of Fluid Therapy in Shock Management: The Complete Evidence Based On New Scientific Discoveries In Physics, Physiology, And Medicine.
New Scientific Basis of Fluid Therapy in Shock Management: The Complete Evidence Based On New Scientific Discoveries In Physics, Physiology, And Medicine.
