Accident & Emergency OSCE
Traumatology
Answer
a) X ray finding
i. Left thorax radiolucent suggestive of massive pneumothorax
ii. Left lung collapsed
iii. Trachea shifted to the left.
b) Left lung traumatic pneumothorax
c) Management of this patient
- Triage the patient to the red zone with cardiac and oxygen saturation monitoring
- Secure the Airway, breathing and circulation.
- Put patient on high flow mask with oxygen 10-15 L/min
- This patient may require intubation if unconscious in order to protect the airway or if O2 fails to reach >95% on high flow mask.
- Complete the primary and secondary survey
- Insert chest tube to the left thorax at safe triangle.
- Repeat the thorax X ray post chest tube insertion.
- Blood investigation (FBC, GSH, PT/aPTT, ABG)
- Analgesic ( IV morphine 10-15 mg stat) with anti emetic (IV metoclopromide 10 mg stat)
- This patient may require sedation with midazolam if intubated or restless.
- Refer the patient to the surgical team.