Tension pneumos are wild

[AVPU]

Anyone ever see one? I've only read about it in my text. What does one look like in real life?

 

[rhan101277]

Well you can get them with absolutely no trauma at all. They are deadly if left untreated.

Don't really know what you are after with that question.

 

[AVPU]

Well you can get them with absolutely no trauma at all. They are deadly if left untreated.

Don't really know what you are after with that question.

Yes, I've read about both your points.

Hmmm....I'm not after anything specific....just if anyone has ever seen one actually happen on someone. Just like I asked in my original post.

 

[Shishkabob]

I don't know what one looks like in real life, I don't have x-ray vision h34r:

 

[joeshmoe]

I've seen a patient with a pneumothorax. There were no VISIBLE signs aside from signs of obvious respiratory distress. They did have subcutaneous emphysema, which was pretty obvious when you felt the skin around their chest, shoulder and arm, I dont think thats common though.

If its a tension pneumo the only thing you would SEE is maybe tracheal deviation, JVD, or unequal chest rise on inhalation. There would also likely be diminished lung sounds on the affected side.

As for what an X ray would look like, you could google it and see.

 

[AnthonyTheEmt]

I've seen a patient with a pneumothorax. There were no VISIBLE signs aside from signs of obvious respiratory distress. They did have subcutaneous emphysema, which was pretty obvious when you felt the skin around their chest, shoulder and arm, I dont think thats common though.

If its a tension pneumo the only thing you would SEE is maybe tracheal deviation, JVD, or unequal chest rise on inhalation. There would also likely be diminished lung sounds on the affected side.

As for what an X ray would look like, you could google it and see.

Tracheal Deviation is a VERY late sign. Your classic signs of a tension pneumo is JVD, low BP, and diminished or absent breath sounds on one side.

 

[BBFDMedic28]

Fall

I had a pt with one after he fell from approx 45 ft. He had all of the s/s of one. We darted him and pt cond improved.

 

[AVPU]

I had a pt with one after he fell from approx 45 ft. He had all of the s/s of one. We darted him and pt cond improved.

Darted him?

 

[NomadicMedic]

Darted him?

A Needle Decompression. http://en.wikipedia.org/wiki/Tension_pneumothorax#Treatment

 

[usafmedic45]

I've seen one released at autopsy. Sounded like a wet fart. Spontaneous pneumo from a pulmonary bleb in a 25 year old athlete.

I've also seen a few in clinical practice (mostly in patients undergoing mechanical ventilation or being bagged), but they are pretty uncommon since most of the time they get identified before they get to the point of being a "tension" pneumo. If they get to the point of being a tension pneumo it's normally either because someone didn't call for help soon enough or the medical personnel handling the case weren't paying close enough attention. It's not exactly a subtle diagnosis most of the time since there are few other things that will give you a total absence of breath sounds on one side (that doesn't respond to repositioning the ETT) AND tympany.

 

[Shishkabob]

Darted him?

It's slang for needle thoracostomy.

Typically a 14g or larger needle inserted in to the thoracic cavity.

 

[Akulahawk]

I've seen one a few years ago. Wasn't my patient though. The CFRN determined that the patient was developing a tension pneumo and was getting ready to dart the patient when we pulled up to the ED door. This was during ground transport from a helipad that was a bit remote from the ED (couple blocks). The patient was quickly wheeled in to the ED and very shortly thereafter got a thoracostomy tube inserted. I got to see the chest tube insertion. Symptoms related to the Tension pneumo were resolved almost instantly.

 

[Smash]

Absent or decreased breath sounds are also a very unreliable sign, particularly in a loud environment like the back of an ambulance or side of the road. In fact most of the traditional signs (JVD, breath sounds, subcut emphysema) are extremely unreliable to the point of being useless. Percussion may be more accurate, but again I'm not sure how useful it is in the field, particularly when it is not something that is taught/practiced routinely.

14g cannula are also not very useful, they are not long enough to decompress about 25% of tension pneumothoraces that are present.

The term "Darting" also makes me feel physically ill with it's inappropriateness. It's like "cutting their throat" when performing a cricothyrotomy; just don't say it.

 

[FLEMTP]

a previous service i worked at carried 10 ga angiocaths for a needle decompression.. i still have a couple I keep handy in case I encounter one.

Ive seen a fair amount of tension pneumo's... at least a dozen or so.

Usually it takes a few 14 ga needles inserted over the course of a moderately long transport (10-15 min)

have yet to be able to use the 10ga though... im sure that will make a decent difference.

like anything else though, a good assessment and reassessment of your patient is your best tool for detecting one.

If you have a quiet enough enviroment, a hyper resonance upon percussion will also be noted in a tension... seems like that is overlooked as an assessment tool with EMS providers because of the noisy enviroment, but there are times it does come in handy!

 

[MrBrown]

In New Zealand we have just introduced something called a Turkel needle for pneumothorax.

Not something I have seen before, infact I have to tell you the first time I was "chest decompression" as a skill for Intensive Care Paramedic I was absolutely bewildered with no idea what on earth it meant!

Turkel needle

 

[Epi-do]

While I was in medic class, we had a pt that had one after a nasty MVC. It was early in class, and we hadn't been cleared to do any ALS skills yet, so my preceptor did the decompression.

I've had quite a few pt's with pneumos, but they hadn't progressed to the point where they were tension pneumos while I had them, so I just monitored them on the way to the ER, with the appropriate treatments given, but no decompressions.

 

[reaper]

In New Zealand we have just introduced something called a Turkel needle for pneumothorax.

Not something I have seen before, infact I have to tell you the first time I was "chest decompression" as a skill for Intensive Care Paramedic I was absolutely bewildered with no idea what on earth it meant!

Turkel needle

The Turkel needle should be mandatory on all units. They are the best for a decompression.

Most services use 3.5" 14 ga. The problem with them is the flimsy cath. Once the lung re inflates, it bends the cath over and makes it useless then. That is why you have to use multiple ones. The Turkel will not do this and stays open

 

[Flight-LP]

The Turkel needle should be mandatory on all units. They are the best for a decompression.

The Turkel will not do this and stays open

As will the Cook cath which is my personal fav when it comes to needle decompression.

 

[LucidResq]

I've also seen a few in clinical practice (mostly in patients undergoing mechanical ventilation or being bagged), but they are pretty uncommon since most of the time they get identified before they get to the point of being a "tension" pneumo. If they get to the point of being a tension pneumo it's normally either because someone didn't call for help soon enough or the medical personnel handling the case weren't paying close enough attention. It's not exactly a subtle diagnosis most of the time since there are few other things that will give you a total absence of breath sounds on one side (that doesn't respond to repositioning the ETT) AND tympany.

While we're on the subject, is there anything else to say as far as pneumos in general in the ventilated patient... specifically those with trachs?

I'm looking to work in SCI rehab and there are several vented pts with trachs. I see this being a concern for emergent complications.

 

[abuan]

neve seen a tension pneumo while on the road. only seem them in pictures. but i have been to a pt that had a hemo/pneumo. THAT was nuts.

her history was that she just got over pnuemonia a week ago, started coughing while in the shower, finished showering, sat down in the kitchen and started gasping for air per the family.

when we got there she was agonal, and coded within two minutes of contact.

that was a hairy call.