A patient after RTA came with decreased air entry to the left side with very low BP and O2 levels. No hyper-resonance or tracheal deviation, no visible external bleeding. What to d... A patient after RTA came with decreased air entry to the left side with very low BP and O2 levels. No hyper-resonance or tracheal deviation, no visible external bleeding. What to do next: Needle decompression, chest tube, or thoracotomy? No intubation.
Understand the Problem
The question describes a patient who has experienced a Road Traffic Accident (RTA) and presents with signs of decreased air entry on the left side, low blood pressure, and low oxygen levels. Given these symptoms and the absence of other clinical signs (hyper-resonance, tracheal deviation, visible external bleeding), the question asks what the most appropriate next step in management would be. The options provided are needle decompression, chest tube insertion, or thoracotomy, without intubation.
Answer
Start with needle decompression due to the critical presentation.
Given the patient's condition (decreased air entry on one side, very low BP and O2 levels) and the absence of hyper-resonance or tracheal deviation, tension pneumothorax is less likely, but still possible. Needle decompression should be performed first due to the critical presentation. Further steps would depend on the response to this intervention.
Answer for screen readers
Given the patient's condition (decreased air entry on one side, very low BP and O2 levels) and the absence of hyper-resonance or tracheal deviation, tension pneumothorax is less likely, but still possible. Needle decompression should be performed first due to the critical presentation. Further steps would depend on the response to this intervention.
More Information
Needle decompression is a rapid intervention used to relieve pressure in the chest cavity, often caused by a tension pneumothorax. Given the critical state of the patient, it serves as the immediate next step. Other interventions could be considered after initial stabilization and further evaluation.
Tips
A common mistake is to rule out tension pneumothorax based solely on the absence of hyper-resonance or tracheal deviation; these signs may be absent in some cases. Always consider the overall clinical picture.
Sources
- Tension Pneumothorax - StatPearls - NCBI Bookshelf - ncbi.nlm.nih.gov
- Treating Sucking Chest Wounds and Other Traumatic Chest Injuries - jems.com
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