Comments on: You should never take this chest x-ray

By: Unbounded Medicine » Another Tension-type Pneumothorax

Unbounded Medicine » Another Tension-type Pneumothorax — Tue, 27 Dec 2005 07:26:15 +0000

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By: JonMikel, M.D.

JonMikel, M.D. — Thu, 08 Dec 2005 22:12:45 +0000

I just can’t believe that… as you say so right: “even with the diagnosis staring them in the face”.

Please: interns, residents and students: Do not hesitate

By: DrTony

DrTony — Thu, 08 Dec 2005 18:10:38 +0000

I agree. When I was a 4th year medical student, I had just finished a rotation on the trauma service and was on an ICU rotation. My interns/residents were all internal medicine. I was all set to be a surgeon and firmly believed, “Nothing heals like cold hard steel.” One of the residents had attempted an IJ line and the patient became very dyspneic. As you can expect, shifted trachea, distended neck veins, decreased breath sound, hypertympani, etc.

I suggested a needle thoracostomy. Ignored, of course. They got an x-ray and then, even with the diagnosis staring them in the face, consulted general surgery for a chest tube. The surgery resident walked in, pulled a 14g catheter out of his pocket and stuck it in the patient’s chest. Immediate relief.

In the ER, I don’t hesitate to place a needle if I suspect a tension pneumo. You know the best thing (after saving the patient’s life)? No one can ever prove you wrong. After you do the needle, the patient has a pneumo, even if he didn’t before. And then you get another procedure, the chest tube. (tongue in cheek)

By: Unbounded Medicine

Unbounded Medicine — Wed, 09 Nov 2005 07:41:22 +0000

Another Tension-type Pneumothorax

Here is another chest x-ray that shouldn’t have been taken:

As reference, you can trackback this earlier post.
Regards,
JonMikel, M.D.

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