Thursday, November 13, 2014

Collision

A man is brought in by ambulance after a motor vehicle accident with a dramatic open chest wound. The wound is on the left chest. During inspiration, the wound makes a big sucking noise and the mediastinum swings to the right. During expiration, the mediastinum returns to midline. When you look into the wound, during expiration, the injured lung inflates.

Challenge: What's going on here?

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2 comments:

RaH said...

My guess would be a perforation of the thorax with pleura and lung resulting in a tension pneumothorax creation.

December 9, 2014 at 11:11 AM
Craig said...

that's the right thought
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Collision

This is an open pneumothorax where ambient air enters through a traumatic chest wall defect during inspiration (a sucking wound). During expiration, air exits the pleural space through the chest wall defect and expiratory air from the normal lung fills the collapsed lung (pendulum air) leading to mediastinal flutter.

Source: UpToDate.

December 11, 2014 at 1:43 PM

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