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International Expert Consensus and Recommendations for Neonatal Pneumothorax Ultrasound Diagnosis and Ultrasound-guided Thoracentesis Procedure
Published on: March 12, 2020
[Polytrauma with tension pneumothorax with inserted chest tube]
H V Genzwürker1, A Volz, C Isselhorst
1Institut für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Mannheim.
Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
|December 20, 2005
Summary
A polytrauma case highlights challenges in thoracic injury management. Misplaced chest tubes can mask severe injuries, delaying critical interventions and impacting patient survival in severe thoracic trauma.
Area of Science:
- Trauma Surgery
- Emergency Medicine
- Thoracic Surgery
Background:
- A 25-year-old female sustained polytrauma from a 12-meter fall.
- Initial management included endotracheal intubation and mechanical ventilation.
Observation:
- Abdominal ultrasound revealed free fluid, suspecting liver and spleen rupture.
- A chest tube was inserted for diminished breath sounds, draining 300ml of blood.
- Laparotomy confirmed and treated liver and spleen ruptures.
Findings:
- The patient developed hypotension, ventricular tachycardia, and fibrillation.
- A tension pneumothorax was suspected, leading to thoracotomy.
- Ruptures of the right mainstem bronchus, pulmonary artery, and subclavian vein were found.
- The chest tube was dislocated subcutaneously, masking injuries.
Implications:
- This case underscores difficulties in thoracic trauma management, especially with subtle symptoms.
- Chest tube placement and monitoring are critical to avoid misdiagnosis and delayed treatment.
- Spiral CT, routine bronchoscopy, and safe chest tube practices may improve outcomes in polytrauma patients.
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