30 yea raid female comes with acute breathelessness, neck vein distension, absent breath sounds and mediastinal shift. Which of the following should be done immediately: (PGI June 2008)
Ans.: D {Large bore needls puncture of thorax) (Ref Harrison 17th/1660; Oxford Textbook of Surgery'/1932}The young lady from the case history is suffering from tension pneumothorax.The immediate management of such patient should be large bore neelds punctureQ of thorax through second anterior intercostals space to save the life- Oxford Textbook of Surgery/1932X-ray is used for confirmation of diagnosis, but urgent order is not requiredABC & HRCT is not necessaryFig.: Needle Insertion & thoracostomy tubeTension Pneumothorax Harrison I7th/1660# This condition usually occurs during mechanical ventilation or resuscitative efforts.The positive pleural pressure is life-threateningQ both because ventilation is severely compromised and because the positive pressure is transmitted to the mediastinum, which results in decreased venous return to the heart and reduced cardiac output.Difficulty in ventilation during resuscitation or high peak inspiratory pressures during mechanical ventilation strongly suggests the diagnosis.The diagnosis is made by physical examinationQ showing an enlarged hemithorax with no breath sounds, hvperresonance to percussion, and shift of the mediastinum to the contralateral side.Tension pneumothorax must be treated as a medical emergencyQIf the tension in the pieural space is not relieved, the patient is likely to die from inadequate cardiac output or marked hypoxemia.A large-bore needleQ should be inserted into the pleural space through the second anterior intercostal space. If large amounts of gas escape from the needle after insertion, the diagnosis is confirmed. The needle should be left in place until a thoracostomy tube can be inserted
HRCT Ls the investigation of choice
ABG analysis should be done
CXR
Large bore needle puncture of pleura
Pulmonary Diagnostic Procedures