Daily answser

[Scott Rand]

 

.  A tall thin wide receiver is tackled hard on the field.  He comes off the field complaining of shortness of breath and some right sided upper chest pain.  His chest wall is non tender to palpation.  You choose to observe him and then are distracted by another injury on the field.  On your return, you find him markedly short of breath.  He is mildly cyanotic, has distended neck veins and you note the trachea deviated to the left.  What diagnosis are you most concerned about and what is the indicated emergency procedure?

 

This presentation is indicative of a tension pneumothorax caused by rupture of an emphysematous bleb in the apex of the right lung.   Needle decompression is indicated in the setting of severe respiratory distress and x-ray confirmation is actually not indicated.   Place a 14-16 gauge needle into the chest cavity just over the 3^rd rib on the affected (right) side in the midclavicular line.  Immediate decompression should be noted along with improvement in symptoms.

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Scott E Rand, MD  FAAFP CAQSM

Director, Primary Care Sports Medicine Fellowship

Co Director of Sports Medicine, Houston Methodist Orthopedics and Sports Medicine Willowbrook

Assistant Professor of Clinical Family Medicine  Houston Methodist Academic Institute

Adjunct Assistant Professor of Family and Community Medicine, Texas A&M University

Assistant Professor of Family Medicine in Clinical Medicine  Weill Cornell Medical College.

13802 Centerfield Dr  Suite 300

Houston, TX  77070