Jugular distension

[Austin carawan]

if you have lung sounds on the right, but not on the left, and jugular veins are distended, and the trachea has shifted to the right, what is going on? Resp. 32 shallow pulse 120 and bp110/70 with cold clammy skin. Any help is appreciated

 

[Summit]

What do you think the answer to your homework question might be?

 

[Jim37F]

Sounds like a homework question. What do you think is going on and why? What would be causing those signs? What anatomy or physiology would be pulling on the trachea like that?

 

[Austin carawan]

I'm pretty sure I'm dealing with a pneumothorax, but I always thought if you had right lung sounds, the trachea would be pushed and shifted to the left by the right lung, or have I got a tension pneumothorax?

 

[Austin carawan]

Sounds like a homework question. What do you think is going on and why? What would be causing those signs? What anatomy or physiology would be pulling on the trachea like that?

was I looking at backwards? It's the air escaping the damaged lung filling the pleural space causing tracheal deviation isn't it???

 

[Jim37F]

There's something in the chest (thats most def where it shouldn't be) that's affecting the left lung so you can't hear lung sounds on that side. Air and _____? Fill in the blank, apply a bit of logic to what the blank will do to the trachea and R lung from where it's sitting in the left side and you'll have your answer.

 

[Austin carawan]

Is blood what you are hinting at?

There's something in the chest (thats most def where it shouldn't be) that's affecting the left lung so you can't hear lung sounds on that side. Air and _____? Fill in the blank, apply a bit of logic to what the blank will do to the trachea and R lung from where it's sitting in the left side and you'll have your answer.

 

[Jim37F]

Eh, I was actually trying to hint towards pressure, but I just reread what I wrote and I could've been clearer towards that ha, but basically what you said just above that....Air causes pressure pushing on all the other structures inside the chest.

 

[Austin carawan]

Oh, yep I had it backwards entirely, so the pressure from the air builds up and pushes the whole system. I'm with you now. And that's a als procedure to do decompression.. As far as I know that's the only effective treatment for this patient

 

[Gurby]

Oh, yep I had it backwards entirely, so the pressure from the air builds up and pushes the whole system. I'm with you now. And that's a als procedure to do decompression.. As far as I know that's the only effective treatment for this patient

Do you suppose ALS is going to stick a needle in this guy's chest?

 

[Austin carawan]

That's what I had in mind yes, am I overlooking something?

 

[Gurby]

That's what I had in mind yes, am I overlooking something?

What's the difference between a pneumothorax and a tension pneumothorax?

 

[Austin carawan]

Let's see if I have this right, a pneumothorax is simply air in the pleural space, while a tension pneumothorax is when structures shift to the opposite side because of the built up pressure from that air

 

[Jim37F]

Right, it'd a progression. Where in that progression would you see a particular sign an assessment will reveal that mark the difference and cause a medic to start thinking decompression? It's a sign you can find as an EMT and will find before the trachea has started to noticeably shift.

 

[Gurby]

Let's see if I have this right, a pneumothorax is simply air in the pleural space, while a tension pneumothorax is when structures shift to the opposite side because of the built up pressure from that air

Not exactly... What complications could arise from a pneumothorax? What are we most concerned about?

 

[Austin carawan]

To Jim, jugular distension is a very late sign, so mark that out, would you find rigidness on that side of the chest? Or is the absence of lung sounds on only one side where I should be headed?

 

[Austin carawan]

To gurby, your primary concern is your patients abcs, should we be concerned that he is being adequately ventilated?

 

[Gurby]

To gurby, your primary concern is your patients abcs, should we be concerned that he is being adequately ventilated?

That's a concern, sure. But what else could happen? We have all that air building up in the chest, pushing on and compressing things... What else is in the chest that we need to worry about?

I'm certainly not an expert, but I think most patients with tension pneumo don't die from hypoxia secondary to ventilation issues. They die of something else before it gets to that point...

 

[Jim37F]

That's a concern, sure. But what else could happen? We have all that air building up in the chest, pushing on and compressing things... What else is in the chest that we need to worry about?

I'm certainly not an expert, but I think most patients with tension pneumo don't die from hypoxia secondary to ventilation issues. They die of something else before it gets to that point...

if you have lung sounds on the right, but not on the left, and jugular veins are distended, and the trachea has shifted to the right, what is going on? Resp. 32 shallow pulse 120 and bp110/70 with cold clammy skin. Any help is appreciated

 

[Gurby]

I feel like one part of that patient description is wrong...