You respond to 40 y/o with chest pains and coughing

Qulevrius

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The part that highlighted to me that it was hemothorax was the “chest rise and fall diminished on left side” but after reading it again “coughing up blood” it could in fact be hemoptysis since hemothorax technically means blood in the pleural space
Hemo and pneumo do not present the same. Diminished/absent unilateral chest fall and rise is characteristic of tension pneumo, not hemo. Other s&s apply, including abnormal percussion, trach deviation etc. And hemoptysis, by definition, is coughing up blood.
 
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Tigger

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Hemo and pneumo do not present the same. Diminished/absent unilateral chest fall and rise is characteristic of tension pneumo, not hemo. Other s&s apply, including abnormal percussion, trach deviation etc. And hemoptysis, by definition, is coughing up blood.
Well, until it's a hemopneumothorax...
 

iExposeDeformities

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Hemo and pneumo do not present the same. Diminished/absent unilateral chest fall and rise is characteristic of tension pneumo, not hemo. Other s&s apply, including abnormal percussion, trach deviation etc. And hemoptysis, by definition, is coughing up blood.
So you’re telling me that if large volumes of blood fill into the pleural space thereby preventing the lungs from expanding as much as they should, chest rise and fall will be bilaterally equal/normal?
 
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Qulevrius

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So you’re telling me that if large volumes of blood fill into the pleural space thereby preventing the lungs from expanding as much as they should, chest rise and fall will be bilaterally equal/normal?
What I’m saying is that you should consider brushing up on your understanding of clinical presentations. Starting with going back to, and rereading, the OP.
 

iExposeDeformities

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What I’m saying is that you should consider brushing up on your understanding of clinical presentations. Starting with going back to, and rereading, the OP.
I know hemo and pneumo do not present entirely the same. What I am saying though is unequal chest rise is also a presentation of hemothorax. If you don’t realize why maybe I’m not the one who needs to “brush up”
 
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Qulevrius

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I know hemo and pneumo do not present entirely the same. What I am saying though is unequal chest rise is also a presentation of hemothorax. If you don’t realize why maybe I’m not the one who needs to “brush up”
Why won’t you enlighten us and explain the physiological reasons for having an asymmetrical chest rise/fall.
 

iExposeDeformities

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Why won’t you enlighten us and explain the physiological reasons for having an asymmetrical chest rise/fall.
Blood fills into pleura and limits lung expansion. Both blood and air will take up pleural space which is why both pneumo and hemo have unequal chest rise and fall
 
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Qulevrius

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Blood fills into pleura and limits lung expansion. Both blood and air will take up pleural space which is why both pneumo and hemo have unequal chest rise and fall
So per scenario, you have a tachypneac, desatting pt with diminished unilateral chest movement, hemoptysis & OK’sh bp, and that cues you in on hemothorax ?

The part about my question that went 20 ft over your head was ‘why is it happening’, not ‘what’s the outcome’.
 

iExposeDeformities

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So per scenario, you have a tachypneac, desatting pt with diminished unilateral chest movement, hemoptysis & OK’sh bp, and that cues you in on hemothorax ?

The part about my question that went 20 ft over your head was ‘why is it happening’, not ‘what’s the outcome’.
100/76 would be considered ok depending on the pulse which we don’t have. If pt is tachycardic as well then it would probably point to hemo as hypovolemia is the major difference between pneumo and hemo. After further analyzing it could be a pneumo. You didn’t ask me why it’s happening. All I’m doing is telling you it’s possible for a hemothorax to present with unequal chest rise and I told you why
 

Akulahawk

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So per scenario, you have a tachypneac, desatting pt with diminished unilateral chest movement, hemoptysis & OK’sh bp, and that cues you in on hemothorax ?
100/76 would be considered ok depending on the pulse which we don’t have. If pt is tachycardic as well then it would probably point to hemo as hypovolemia is the major difference between pneumo and hemo. After further analyzing it could be a pneumo.
Given the presentation of the patient as a tachpneic, desatting patient with diminished unilateral chest movement, hemopytysis with a BP of 100/76, I don't think that determining the exact cause of the immediate problem is truly what you need to do. From what I see so far, there's a brewing issue that will very rapidly require immediate action that, if not taken, will result in the death of the patient. The presentation doesn't shout to me "Hi, I'm a hemothorax!" It really doesn't, not a pure one anyway.

Furthermore, regardless of the patient's pulse rate, I would expect that a BP of 100/76 to be, shall we say, a bit alarming in an adult patient, given the signs we've uncovered. By the book, it's "Ok-ish" but if you think about what's coming very quickly... it should make you very worried about this one.
 

Qulevrius

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Given the presentation of the patient as a tachpneic, desatting patient with diminished unilateral chest movement, hemopytysis with a BP of 100/76, I don't think that determining the exact cause of the immediate problem is truly what you need to do. From what I see so far, there's a brewing issue that will very rapidly require immediate action that, if not taken, will result in the death of the patient. The presentation doesn't shout to me "Hi, I'm a hemothorax!" It really doesn't, not a pure one anyway.

Furthermore, regardless of the patient's pulse rate, I would expect that a BP of 100/76 to be, shall we say, a bit alarming in an adult patient, given the signs we've uncovered. By the book, it's "Ok-ish" but if you think about what's coming very quickly... it should make you very worried about this one.
There’s a lot of ‘what-ifs’ and gaping holes in the scenario. You see one piece of it and go ‘uh-huh’, followed by ‘oh wait’ and ‘uh-oh’. Extrapolating is always fun, just have to remember that this thread was, and still is, a big bad joke.

But if you want my serious opinion on this, then I’d suspect either a major trauma to the rib cage/chest wall (no visual presentation is offered) or a bunch of comorbidities that affected lung integrity.
 

Akulahawk

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Also per scenario:
Your partner then goes into sudden cardiac arrest
Since you're EMS, chances are pretty good that your partner's SCA is due to caffeine overdose (too much coffee/redbull/etc) touching off Vtach ->VFib... you immediately perform a sharp precordial thump, bringing your partner back from the dead and now you're back to the original problem.
 
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