A Patient presented to emergence after A with multiple rib fractures. He is conscious speaking single words. On examination, respiratory rate was 40/minute and BP was 90/40 mmHg. What is immediate next step?
(A) Urgent IV fluid administration (B) Intubate the patient (C) Chest X-ray (D) Needle inseion in 2nd intercostal space
(D) A + Multiple Rib Hemothorax Pneumothorax Tension Pneumothorax Flail chest with pulmonary contusion Conscious + Speaking Single words Dyspnea Tachypnea - RR - 40 min - Tachypnea - BP - 90/40 mmHg - Low BP TENSION Pneumothorax Multiple Rib Dyspnea Tachypnea Low BP Tension Pneumothorax: d/t "One-way valve" air leak Complete collapse of punctured lung Mediastinum - opposite side displacement | venous return M/C Penetrating chest trauma. Blunt chest trauma with air leak Latrogenic Clinical Picture: Restlessness Tachypnea Dyspnea Distended neck veins. Management: Clinical dx with dire emergency T/t should be never delayed for radiological confirmation. Hence, CXR is not performed. Treatment: Immediate decompression + wide bore needle into 2nd ICS - mid-clavicular line T/f of choice: ICT inseion - 5th ICS (Triangle of Safety) in anterior axillary lines Triangle of Safety:Boundaries:Anterior- Lat. Border of Pec. MajorPosterior- Lat. border of Latissimus dorsiSuperior/Apex- Base of AxillaInferior/Base- Line passing through 5th ICS