A 33-year-old man was brought to the Emergency Department after a high velocity trauma. He had distended neck veins and markedly decrease breath sounds on the right side. Heart rat... A 33-year-old man was brought to the Emergency Department after a high velocity trauma. He had distended neck veins and markedly decrease breath sounds on the right side. Heart rate 105/min, Blood Pressure 90/60 mmHg, Oxygen saturation 85%. Which of the following is the most likely cause? A. Flail chest B. Right hemothorax C. Pericardial tamponade D. Right tension pneumothorax Read more

Understand the Problem

The question describes a patient with symptoms of trauma, including distended neck veins, decreased breath sounds, and hypotension. It asks us to identify the most likely cause of these symptoms from the given options. The key is to recognize the constellation of signs suggestive of a specific thoracic injury.

More Information

A tension pneumothorax occurs when air enters the pleural space but cannot escape, leading to increased pressure in the chest. This can cause lung collapse, decreased breath sounds, and distended neck veins due to impaired venous return. The patient's vitals (HR 105, BP 90/60, SpO2 85%) indicate shock, which can be caused by tension pneumothorax.

Here's why the other options are less likely:

• Flail chest: This involves multiple rib fractures, leading to paradoxical chest movement. While it can cause respiratory distress, it doesn't directly explain the distended neck veins.
• Right hemothorax: This is blood in the pleural space. While it can decrease breath sounds and cause shock, it doesn't typically cause distended neck veins unless massive.
• Pericardial tamponade: This involves fluid accumulation around the heart, impairing its ability to pump. It typically presents with muffled heart sounds, distended neck veins, and hypotension (Beck's triad). However, the question mentions decreased breath sounds, which is more consistent with a pneumothorax.

Tips

A common mistake is confusing tension pneumothorax with other conditions that cause respiratory distress or shock. Remember the key signs of tension pneumothorax: decreased breath sounds on one side, distended neck veins, and signs of shock.

Sources

• Trauma and Critical Care Flashcards by Monica B - Brainscape - brainscape.com