Tension pneumos are wild

I've seen around the net an example of bilateral haemopneumothracies.

Shall try to find the video.
 
MrBrown said:
haemopneumothracies.
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Get that on the triple word score, and you win, hands down.

I'm curious as to what sort of MOI creates a bilateral hemopneu... err... haemo.... err... buildup of blood and air in the pleural space.
 
AnthonyTheEmt said:
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.
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I knew it, the ems gods hate me.

Tracheal deviation is a classic sign of a Pneumo, especially one developing to tension. It is not the late, gross deviation which seems to be spouted like gospel from EMS academy instructors like the lord's prayer in a catholic church.

If you draw an imaginary line between your mandibular symphisis and your jugular notch of the sternum. Tracheal devation is when the trachea is shifted 3mm or more to either side anywhere along that line. (but usually near the bottom.)

3mm is very small, but even when it starts to get to as little as 5mm or 10mm it is noticable if you properly expose, inspect, and sometimes palpate for it.

If you want to see something it really really helps to know what you are looking for.
 
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I'd say mostly trauma however I wouldn't be suprised if could be some medical reasons for it.
 
If you think tension pneumos are "wild" I'd hate to see what you say about Hemothoracies... or hemopneumos.
 
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.
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Generally they are the sign of either a displaced tube or inappropriate ventilator settings (excessive volumes, insufficient time for exhalation (excessive rate), etc) for the clinical findings of the patients.

The former sually from an ETT tube being pushed down into the mainstem and someone not catching it and continuing to bag the patient (hence the joke about the leading cause of pneumos being overzealous EMTs named Bubba). In effect it's the pulmonary equivalent of the old saying about "cramming ten pounds of **** into a five pound bag". The "extra" volume has to go somewhere and that "somewhere" is frequently the pleural space. It's pretty hard to miss this on a patient on the ventilator unless the alarms are blatantly ignored or inappropriately set. If the alarms are set appropriately, the vent will squawk and scream when you get this sort of scenario. Also if you're patient is conscious, it's going to be obvious they are in distress. Displacement is not a big problem in trachs except in very new trachs, but then the issue is more with subcutaneous displacement than with something causing a pneumo...in this case, you'd wind up with subcutaneous emphysema rather than a pneumo. On rare occasions it can cause a pneumomediastinum but I've only seen that once in a trach patient

The other circumstance is pretty much only an issue if you have a truly, truly, truly unrepentently stupid doctor who won't listen to his RTs. I've encountered this a few times.

If you get the job, talk to the RTs at the facility and have them teach you the ins and out of mechanical ventilation. Most of us are eager to teach anyone who is willing to learn. Sadly, a lot of nurses, patient care techs and EMS personnel are resistant to efforts to teach them and to correct their mistakes.

I'm curious as to what sort of MOI creates a bilateral hemopneu... err... haemo.... err... buildup of blood and air in the pleural space.
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First: Hemopneumothorax or hemopneumothoraces, if you're going for the triple word score. Pneumomediastinum is another good one. Chylothorax and pyothorax are also fun ones to throw out there.

Actually a lot of trauma-induced "pneumos" or hemothoraces are technically a mix of the two, especially in the case of penetrating trauma to the lung. About the only way you wind up with a "pure" pneumothorax is a non-traumatic bleb rupture and the only common way to get a "pure" hemothorax is isolated vascular trauma (blunt or penetrating) or an aortic aneurysm rupture.
 
Thank you. I'll definitely be bugging the RTs if I get the job there. I'll tell you one thing I've learned... showering a ventilated quad with a trach is quite the ordeal.
 
I'll tell you one thing I've learned... showering a ventilated quad with a trach is quite the ordeal
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That's a reason why:
-I am glad I no longer work for a rehab hospital/LTAC unit.
-I made myself scarce when it was bath time when I did.
 
abuan said:
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.
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Would be called a spontaneous hemo/pneumothorax, since it, apparently, occured during a coughing fit?
 
adamjh3 said:
Would be called a spontaneous hemo/pneumothorax, since it, apparently, occured during a coughing fit?
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Could be a number of things....she could have ruptured an aortic aneurysm during the coughing fit, blown out a bleb, etc. You can't really make the call without seeing the autopsy report.
 
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