PRESENTING AUTHOR – Dr. SRUTHI.P,
FIRST YEAR EMERGENCY MEDICINE
Dr. NITHYARAJ (AP), SMVMCH
Dr. KIRUBASHANKAR (SR), SMVMCH
INTRODUCTION
Tension pneumothorax is an uncommon condition with a high mortality rate most frequently reported to occur in prehospital, emergency department, and intensive care unit (ICU) settings. This condition is frequently lethal without early diagnosis and treatment. While reason for occurrence of Pneumothorax can be traumatic or non-traumatic. In this particular case the occurrence was not due to trauma, but a spontaneous ruptured blebs.
CASE DESCRIPTION:
A 20 year old male was referred to ER with complaints of breathing difficulty since morning. Initially patient had complaints of right sided chest pain and progressively developed breathing difficulty, he was immediately taken to a nearby hospital and had an episode of vomiting while ambulating, he was evaluated, as patient started to desaturate, he was referred to higher centre. On arrival his SpO2-84% @ room air, BP-80/40mmHg, PR-82 b/min, GCS- 15/15. Systemic examination was done, on inspection his chest wall was symmetrical with equal chest rise and no bony crepitus. On percussion hyperresonance was present on the right chest wall. Auscultation–reduced to absent breath sounds on right hemithorax, bedside chest x ray and POCUS was done showing a positive barcode sign and absence of sliding. Chest x ray revealed Right visceral pleura line suggestive of pneumothorax. Immediately bed side needle decompression was done over right safe triangle, post procedure CT thorax was obtained revealed a right fully collapsed lung, under aseptic precaution over right safe triangle ICD tube was placed and fixed, position was confirmed by bed side chest x ray. Post ICD patient improved symptomatically and his overall vitals stabilized. Expert opinion was obtained from Pulmonology team and explorative bronchoscopy was done as serial CT showed inadequate recoiling of the right lung and pleural bleb in the right upper lobe. In view of persistent air leak autologous blood patch pleurodesis was done by pulmonology team and was monitored with serial chest x rays, On the 5th day after pleurodesis, ICD was clamped for 24hrs and was removed as there was no pneumothorax on the x ray. Patient was managed symptomatically and was discharged.
CONCLUSION:
The successful treatment of a tension pneumothorax depends on early recognition, proactive intervention, and early consideration by emergency and trauma care physician. Once the diagnosis is confirmed, early needle decompression and ICD placement should be considered. In this case the cause was a rare being a ruptured blebs, our timely approach and presence of mind has saved the life of the patient.