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:

  1. RaHDecember 9, 2014 at 11:11 AM

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

    ReplyDelete
  2. CraigDecember 11, 2014 at 1:43 PM

    that's the right thought
    -
    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.

    ReplyDelete

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