Whoa!!! Please Learn From This Case

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jetproppilot

jetproppilot

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Learn to trust the little birdy sitting on your shoulder saying HEY DUDE!! SOMETHING AINT RIGHT!!!

Thats the only thing that saved me from an insidious, potential disaster last week.

45 year old ASA 2 (asthma, well controlled, no recent exacerbations) for a laparoscopic vaginal hysterectomy (LAVH).

Nice lady.

Lungs clear.

Has had surgery before without incident.

Blah blah blah.

We induce.

CRNA doesnt see s hit on laryngoscopy.

No problem, I'm thinking to myself as I find a Miller 2, my favorite blade. I've convinced myself I can intubate a gravid fire ant with that blade.

I go to the head of the bed, check everything (suction, etc), ask for a little more propofol and sux, crank on some maxazizzle sevo for thirty seconds or so of hyperventilation, optimize her position, and dive in.

Uhhhhhhhhhhhh....I can intubate a gravid ant. Since I dont see sheeat, this must be a neonatal ant. :laugh:

Seriously, I didnt see a thing. Could get under the epiglottis but never even saw the aretynoids.

So I called for help.

Ventilating away. No problems with patent airway.

Deft partner shows up as does an anesthesia tech with difficult airway cart.

Fast Trach slid in by partner.

Cant get the tube thru the LMA.

Even looking subsequently thru a scope.

ALRIGHT, f uk this, I say to myself.

I'm gonna take one fiberoptic look. If I fail, we wake her up.

Lady is starting to breathe a little, so I thank my partner and tell her I've got it.

Out comes LMA.

In goes nasal scope with a tube threaded on it.

She is breathing now, so I'm taking my time, looking for the holy grail white things moving laterally and medially.

BINGO!!!

Able to snake scope thru white thingies (a.k.a. vocal cords for med students, etc)

Tube follows scope.

So our hard work is done.

Surgery is technically difficult, requiring steep trendelenberg. So our peak pressures are in the forties....high, yeah, but not abnormal for a laparoscopic case with steep trendelenberg.

Cuppla hours later case is over.

Breathing on her own, good tidal volumes, etc, sats great,

extubate.

Doing fine.

Except this weird cough.

With a resonant quality to it that I could appreciate just listening to it.

Oh well.

She's got a history of asthma, I think to myself. We've irritated her bronchial tree. Nothing a little albuterol can't fix.

To PACU.

Vitals stable, so I leave to take care of other stuff.

Check on her 30 min later.

She is lucid now. Smiling. And thankful (I told ya she was nice!). Sats 99%. No dyspnea. No tachypnea. So I talk with her for a few minutes. Ask her how her pain is. Pain meds helping. Nausea? Nope.

Great.

Cuppla more of those resonant sounding coughs happen during our conversation.

I leave.

30 minutes later PACU nurse calls me to make sure its OK to send her back to day surgery.

Says she's satting fine, no dyspnea, pain OK, no nausea.

But still has that weird cough.

This is where the little birdy comes in.

99/100 times I say send'em to Day Surg.

Over the phone.

But something told me I should go see her and auscultate her chest.

So I did.

And I didnt hear a f ukking thing on the right side!!

I'm trying to talk myself outta what I just heard. Sats OK, she is speaking in full sentences without SOB, resp rate 18.........

NAWWWWWWW......

"Lets get a portable chest before we send her," I tell the PACU nurse.

30 minutes later I get called to come look at the x ray.

It's up on the PACU viewing box when I walk in.

:scared:

Shes got a total right lung collapse!!!

Right hemithorax jet black, with a little hint of lung tissue all curled up at the right main stem.

:eek:

So I was THIS CLOSE to sending an asymptomatic post-LAVH lady home with a complete right sided pneumo.

I go find the chest surgeon, show him the CXR.

"WOW," he said.

I go talk with the lady and her family. Tell her what happened, and what needs to happen.

She gets the chest tube in PACU. Stays in the hospital a cuppla days longer than expected.

Does fine.

WHY DID THIS HAPPEN???

Don't really know, although I'm sure the difficult airway, steep trendelenberg, and C02 in her belly with concominant high airway pressures contributed.

But we do steep trendelenberg and high airway pressures all the time without incident.

I think she had a bleb somewhere that popped from all the above. A bleb that probably wouldnt've given her any issues thru her lifetime without all the above happening at once.

I'm sure you guys can help me speculate.

But the message of this post is if your intuition is telling you something aint quite right, like mine did as a result of hearing that resonant cough several times, LISTEN TO YOUR INTUITION!!!

One wouldve expected her to show something clinically after looking at the CXR......she was operating on one lung with no dyspnea, no tachypnea, and a 99% sat.

Could've easily sent her home.


Thank God I didnt.

Oh...and the resonant cough I kept mentioning....sounded like that since half of her chest was hollow....with no lung tissue.

Didnt know you could appreciate a pneumo (at least hers) by the quality of her cough.

I learn something new every day in this biz.
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jetproppilot said:
Learn to trust the little birdy sitting on your shoulder saying HEY DUDE!! SOMETHING AINT RIGHT!!!

Thats the only thing that saved me from an insidious, potential disaster last week.

45 year old ASA 2 (asthma, well controlled, no recent exacerbations) for a laparoscopic vaginal hysterectomy (LAVH).

Nice lady.

Lungs clear.

Has had surgery before without incident.

Blah blah blah.

So we induce.

CRNA doesnt see s hit on laryngoscopy.

No problem, I'm thinking to myself as I find a Miller 2, my favorite blade. I've convinced myself I can intubate a gravid fire ant with that blade.

So I go to the head of the bed, check everything (suction, etc), ask for a little more propofol and sux, crank on some maxazizzle sevo for thirty seconds or so of hyperventilation, optimize her position, and dive in.

Uhhhhhhhhhhhh....I can intubate a gravid ant. Since I dont see sheeat, this must be a neonatal ant. :laugh:

Seriously, I didnt see a thing. Could get under the epiglottis but never evern saw the aretynoids.

So I called for help.

Ventilating away. No problems with patent airway.

Deft partner shows up as does an anesthesia tech with difficult airway cart.

Fast Trach slid in by partner.

Cant get the tube thru the LMA.

Even looking subsequently thru a scope.

ALRIGHT, f uk this, I say to myself.

Lady is starting to breathe a little, so I thank my partner and tell her I've got it.

Out comes LMA.

In goes nasal scope with a tube threaded on it.

She is breathing now, so I'm taking my time, looking for the holy grail white things moving laterally and medially.

BINGO!!!

Able to snake scope thru white thingies (a.k.a. vocal cords for med students, etc)

Tube follows scope.

So our hard work is done.

Surgery is technically difficult, requiring steep trendelenberg. So our peak pressures are in the forties....high, yeah, but not abnormal for a laparoscopic case with steep trendelenberg.

Cuppla hours later case is over.

Breathing on her own, good tidal volumes, etc, sats great,

extubate.

Doing fine.

Except this weird cough.

With a resonant quality to it that I could appreciate just listening to it.

Oh well.

She's got a history of asthma, I think to myself. We've irritated her bronchial tree.

To PACU.

Vitals stable, so I leave to take care of other stuff.

Check on her 30 min later.

She is lucid now. Smiling. And thankful (I told ya she was nice!). Sats 99%. No dyspnea. No tachypnea. So I talk with her for a few minutes. Ask her how her pain is. Pain meds helping. Nausea? Nope.

Great.

Cuppla more of those resonant sounding coughs happen during our conversation.

So I leave.

30 minutes later PACU nurse calls me to make sure its OK to send her back to day surgery.

Says she's satting fine, no dyspnea, pain OK, no nausea.

But still has that weird cough.

So this is where the little birdy comes in.

99/100 times I say send'em to Day Surg.

Over the phone.

But something told me I should go see her and auscultate her chest.

So I did.

And I didnt hear a f ukking thing on the left side!!

So I'm trying to talk myself outta what I just heard. Sats OK, she is speaking in full sentences without SOB, resp rate 18.........

NAWWWWWWW......

"Lets get a portable chest before we send her," I tell the PACU nurse.

30 minutes later I get called to come look at the x ray.

It's up on the PACU viewing box when I walk in.

:scared:

Shes got a total right lung collapse!!!

Right hemithorax jet black, with a little hint of lung tissue all curled up at the right main stem.

:eek:

So I was THIS CLOSE to sending an asymptomatic post-LAVH lady home with a complete right sided pneumo.

So I go find the chest surgeon, show him the CXR.

"WOW," he said.

I go talk with the lady and her family. Tell her what happened, and what needs to happen.

She gets the chest tube in PACU. Stays in the hospital a cuppla days longer than expected.

Does fine.

SO, WHY DID THIS HAPPEN???

Don't really know, although I'm sure the difficult airway, steep trendelenberg, and C02 in her belly with concominant high airway pressures contributed.

But we do steep trendelenberg and high airway pressures all the time without incident.

I think she had a bleb somewhere that popped from all the above. A bleb that probably wouldnt've given her any issues thru her lifetime without all the above happening at once.

I'm sure you guys can help me speculate.

But the message of this post is if your intuition is telling you something aint quite right, like mine did as a result of hearing that resonant cough several times, LISTEN TO YOUR INTUITION!!!

One wouldve expected her to show something clinically after looking at the CXR......she was operating on one lung with no dyspnea, no tachypnea, and a 99% sat.

Could've easily sent her home.

Thank God I didnt.
Click to expand...
WOW!
Some people have asymptomatic bullae in their lungs waiting for positive pressure ventilation to pop.
Do you have a pre-op CXR?
I have once seen a pneumothorax after Fiberoptic intubation possibly when the operator shoved the scope all the way in and lacerated a small bronchus.
 
Planktonmd said:
WOW!
Some people have asymptomatic bullae in their lungs waiting for positive pressure ventilation to pop.
Do you have a pre-op CXR?
I have once seen a pneumothorax after Fiberoptic intubation possibly when the operator shoved the scope all the way in and lacerated a small bronchus.
Click to expand...

No preop CXR.

And the fiberoptic was pretty smooth, although thats always a possibility.
 
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what a great pickup! you may have saved that woman's life.

here's a similar report, although this pt desatted, unlike yours.
http://bja.oxfordjournals.org/cgi/content/full/91/2/297

what i don't understand exactly...maybe you can explain it to me:
"When the chest radiograph was examined, the tracheal tube was seen in the right bronchus and the left lung was collapsed with moderate mediastinal shift."

They call it "Unintentional endobronchial intubation." How is this not a ptx? And with that cxr finding of a collapsed lung with mediastinal shift, doesn't that buy this lady a chest tube, or at least needle decompression?
 
gasnewby said:
what a great pickup! you may have saved that woman's life.

here's a similar report, although this pt desatted, unlike yours.
http://bja.oxfordjournals.org/cgi/content/full/91/2/297

what i don't understand exactly...maybe you can explain it to me:
"When the chest radiograph was examined, the tracheal tube was seen in the right bronchus and the left lung was collapsed with moderate mediastinal shift."

They call it "Unintentional endobronchial intubation." How is this not a ptx? And with that cxr finding of a collapsed lung with mediastinal shift, doesn't that buy this lady a chest tube, or at least needle decompression?
Click to expand...

The lung described in your post, gas, is atelectatic. It is still adhered to the chest wall, so it isnt collapsed per se, but it hasnt been ventilated for a while, so its appearance on CXR is white. Since the radiologist is looking at the tube in the right mainstem, he can deduce that the total white out on the left side is due to non ventilation.

The lung is physiologically, yet not anatomically collapsed. Thats why he said it was collapsed.

But the lung is still occupying the hemithorax.

With a pneumothorax, the lung actually collapses, like a popped balloon, and the chest x ray looks totally different. With a total lung collapse...a true pneumo.... that side of the hemithorax looks black.

2 different pathophysiologies. 2 different chest xray appearances.....and yet both situations yield the same physiologic sequelae: a huge intrapulmonary shunt.

SO, the treatment for your case is not a chest tube. Rather, pull the ETT back and ventilate the lung, and it will fill with air again.

The picture you, and the radiologist have in your head(s) of a normal lung on a chest x ray is a combination of lung parenchyma and air, giving the normal appearance you both recognize. Remove the air and all you are looking at is lung tissue..like with a nonventilated lung, as is with your case.....hence the white appearance. Remove the lung tissue (pneumo) and all you are looking at is air....hence the black appearance.
 
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Thanks for posting that, Jet! Great lesson for all of us to learn (or re-learn)!
 
thanks for taking the time to explain that....i knew i was missing something.
 
Strong work mentor.

Just for my own edification, why go nasal FO vs. oral FO through LMA (with arndt attachment for a bougie just like you would for a blocker).

I wish to learn all things master.
 
VentdependenT said:
Strong work mentor.

Just for my own edification, why go nasal FO vs. oral FO through LMA (with arndt attachment for a bougie just like you would for a blocker).

I wish to learn all things master.
Click to expand...

My partner had tried scoping thru LMA and failed, Venty. I guess the LMA was slightly off center or something cuz she could never get a view.

I figured if she couldnt see it, I'd probably be wasting my time.

I was pretty close to waking the lady up so I figured I'd try something I'm good at (I'm pretty comfy with nasal FOs) before cancelling and waking her up.

So it was a personal preference thing, Venty.
 
Jet,

Great case,what I don't understand is....... was this a lung collapse d/t a mucosal plug or a pneumothorax.
Lung collapse would give a entirely different picture on CXR(tracheal deviation) than a pneumo.
I guess it was a pneumo,as she ended up getting a chest tube.
Correct me if I am wrong

Shes got a total right lung collapse!!!

Right hemithorax jet black, with a little hint of lung tissue all curled up at the right main stem.
 
serenity said:
Jet,

Great case,what I don't understand is....... was this a lung collapse d/t a mucosal plug or a pneumothorax.
Lung collapse would give a entirely different picture on CXR(tracheal deviation) than a pneumo.
I guess it was a pneumo,as she ended up getting a chest tube.
Correct me if I am wrong

Shes got a total right lung collapse!!!

Right hemithorax jet black, with a little hint of lung tissue all curled up at the right main stem.
Click to expand...

i don't think i understand what you're saying.

tension ptx will give you tracheal deviation.

if her lung reinflated s/p chest tube, which i'm assuming it did, then it was a ptx. if you have a mucous plug, usually the lung is white on cxr, and still inflated. a chest tube isn't going to help a mucous plug.
 
Don't have Miller in front of me -- I'm in NJ now. But in the chapter on laparoscopic surgery, one of the things big Miller mentions as a risk during insufflation is pneumothorax. I think the reason Miller gives is about incomplete closure of the pleuroperitoneal membranes. Apparently the CO2 insufflation can also cause tamponade -- again about embryological development.

If someone hasn't posted the details by then, I will look it up in the evening and post.

Definitely an interesting case. Pneumothorax wouldn't have been my first thought either because she was doing so good.

One a related note, do many people on this list use pressure control during laparoscopic surgery. I do, because in my experience I can get the same volume at a lower pressure. You just have to remember to decrease the pressure control setting when the gas comes out, otherwise you would be hyperinflating the lungs. We have new Aisys machines which have a pressure control with volume guarantee mode. So I'm assuming it would dial down the pressure on its own when the gas comes out. I'm waiting for a chance to try it out.
 
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rsgillmd said:
Don't have Miller in front of me -- I'm in NJ now. But in the chapter on laparoscopic surgery, one of the things big Miller mentions as a risk during insufflation is pneumothorax. I think the reason Miller gives is about incomplete closure of the pleuroperitoneal membranes. Apparently the CO2 insufflation can also cause tamponade -- again about embryological development.

If someone hasn't posted the details by then, I will look it up in the evening and post.

Definitely an interesting case. Pneumothorax wouldn't have been my first thought either because she was doing so good.

One a related note, do many people on this list use pressure control during laparoscopic surgery. I do, because in my experience I can get the same volume at a lower pressure. You just have to remember to decrease the pressure control setting when the gas comes out, otherwise you would be hyperinflating the lungs. We have new Aisys machines which have a pressure control with volume guarantee mode. So I'm assuming it would dial down the pressure on its own when the gas comes out. I'm waiting for a chance to try it out.
Click to expand...
If you are doing pressure control then the pressure is constant and the volume changes dynamically to maintain the predetermined pressure, which means: if the intra abdominal pressure is high the machine is going to deliver a lower volume and basically hypoventilate the patient.
Pressure control is particularly valuable in cases where barotrauma is a real concern (Babies for example) in ICU setting where no one is constantly looking at the PIP, or when the lungs are really stiff and you want to do the best ventilation possible within your comfort range of PIP.
In the OR the situation is different and you are constantly watching the PIP and hopefully won't let it exceed reasonable limits.
So you can use any mode you want as long as you know at every moment what exactly you are delivering and how effective your ventilation is.
 
serenity said:
Jet,

Great case,what I don't understand is....... was this a lung collapse d/t a mucosal plug or a pneumothorax.
Lung collapse would give a entirely different picture on CXR(tracheal deviation) than a pneumo.
I guess it was a pneumo,as she ended up getting a chest tube.
Correct me if I am wrong

Shes got a total right lung collapse!!!

Right hemithorax jet black, with a little hint of lung tissue all curled up at the right main stem.
Click to expand...

Hey Jet,

Thanks for sharing this

Watch out, with your new powers the "edit post" button is where the "quote and respond" button used to be...
 
gasnewby said:
i don't think i understand what you're saying.

tension ptx will give you tracheal deviation.

if her lung reinflated s/p chest tube, which i'm assuming it did, then it was a ptx. if you have a mucous plug, usually the lung is white on cxr, and still inflated. a chest tube isn't going to help a mucous plug.
Click to expand...

Jet mentioned lung collapse and pneumothorax in the same breath ,that's what confused me.Ofcourse collapse will white out the lung and cause tracheal deviation towards the collapsed lung and vice versa for pneumo.
 
Thanks for sharing.


This is a pneumothorax for sure. I don't think it is related to the CO2 as this is rapidly absorbed. I believe something perforated during the high pressure ventilation. Being on the right side, the FOB could have had something to do with it. Learning point for me: pts with a pneumo can be clinically stable + everybody should be auscultated post op. Why wasn't this picked up by the nurse in pacu?-I don't know. Everywhere I have been the nurses auscultate a couple of times before discharge. It would be nice to see the nursing records to look for this. Why do people order albuterol without auscultating first?-Beats me. How come nobody auscultated an asthmatic pt in the post op period?-? Definitely there is range for improvement. Makes me cautious of discharging someone else's pts, just because they look fine, when I have no idea of what has happened in the OR. I have a few questions: Should the pt seek compensation for prolonged hospitalization, increased costs, time off work, and/or cosmetic reasons, would she have a case or not? Was the ventilation optimized in the OR to limit the PIP? Was it documented in the chart? I can picture how this would go in court and it's not pretty.
 
urge said:
Should the pt seek compensation for prolonged hospitalization, increased costs, time off work, and/or cosmetic reasons, would she have a case or not? Was the ventilation optimized in the OR to limit the PIP? Was it documented in the chart? I can picture how this would go in court and it's not pretty.
Click to expand...
Well, according to Jet's initial post there is nothing in the management of this patient that seems negligent or could be directly blamed for her post op course.
She was an unexpected difficult intubation but everything was done by the book.
That doesn't mean a hungry lawyer wouldn't try to squeeze a few dollars out of it.
 
rsgillmd said:
Don't have Miller in front of me -- I'm in NJ now. But in the chapter on laparoscopic surgery, one of the things big Miller mentions as a risk during insufflation is pneumothorax. I think the reason Miller gives is about incomplete closure of the pleuroperitoneal membranes. Apparently the CO2 insufflation can also cause tamponade -- again about embryological development.

If someone hasn't posted the details by then, I will look it up in the evening and post.

Definitely an interesting case. Pneumothorax wouldn't have been my first thought either because she was doing so good.

One a related note, do many people on this list use pressure control during laparoscopic surgery. I do, because in my experience I can get the same volume at a lower pressure. You just have to remember to decrease the pressure control setting when the gas comes out, otherwise you would be hyperinflating the lungs. We have new Aisys machines which have a pressure control with volume guarantee mode. So I'm assuming it would dial down the pressure on its own when the gas comes out. I'm waiting for a chance to try it out.
Click to expand...

Yup pressure control is a great option. Some complain about the changes you can get in TV when changing patient position but that's why you pay attention during the case.

I second the comment about PTX during CO2 insufflation and is concerning to me everytime I see patient has developed subq emphysema. It's important to note that you can get not only PTX but pneumomediastinum and potentially AGE especially when high airway pressures have occurred intraoperatively. So a portable cxr is not a bad idea in these situations.
 
urge said:
Thanks for sharing.


This is a pneumothorax for sure. I don't think it is related to the CO2 as this is rapidly absorbed. I believe something perforated during the high pressure ventilation. Being on the right side, the FOB could have had something to do with it. Learning point for me: pts with a pneumo can be clinically stable + everybody should be auscultated post op. Why wasn't this picked up by the nurse in pacu?-I don't know. Everywhere I have been the nurses auscultate a couple of times before discharge. It would be nice to see the nursing records to look for this. Why do people order albuterol without auscultating first?-Beats me. How come nobody auscultated an asthmatic pt in the post op period?-? Definitely there is range for improvement. Makes me cautious of discharging someone else's pts, just because they look fine, when I have no idea of what has happened in the OR. I have a few questions: Should the pt seek compensation for prolonged hospitalization, increased costs, time off work, and/or cosmetic reasons, would she have a case or not? Was the ventilation optimized in the OR to limit the PIP? Was it documented in the chart? I can picture how this would go in court and it's not pretty.
Click to expand...

Would be nice to know what the provider was noticing during the case and what he/she did.
 
thanks for the instructive case JPP:thumbup:
a question from a humble MS
did you use a bougie as part of the difficult airway management - and could this possibly cause a ptx?

PS it's great to have all the guns back on this forum - thanks for coming back guys
 
do you know what has helped me for those neonatal fireants?

i would have the resident/crna/other attending/whoever do the DL and lift ALL the soft-tissue out of the way, then i would place fiberoptic in pharynx and then snake my way ---- it makes a HUGE difference when somebody is already doing the laryngoscopy with the extra light source...
 
Damn - feels like the old SDN days.

Good look on that post Jet. Stay around a while, will ya?

dc
 
toughlife said:
Would be nice to know what the provider was noticing during the case and what he/she did.
Click to expand...

I was in and out of the case many times. There was really nothing special to notice during the case from our perspective....no desats, no abrupt PIP increases....yes the PIPs were high but not any higher than one would expect during a laparoscopic case with Trendelenberg.
 
Tenesma said:
do you know what has helped me for those neonatal fireants?

i would have the resident/crna/other attending/whoever do the DL and lift ALL the soft-tissue out of the way, then i would place fiberoptic in pharynx and then snake my way ---- it makes a HUGE difference when somebody is already doing the laryngoscopy with the extra light source...
Click to expand...

Yes. Great idea, great technique.
 
JobsFan said:
thanks for the instructive case JPP:thumbup:
a question from a humble MS
did you use a bougie as part of the difficult airway management - and could this possibly cause a ptx?

PS it's great to have all the guns back on this forum - thanks for coming back guys
Click to expand...

The bougie is a great adjunct, Jobs.

It has cut my fiberoptic needs to almost nil on difficult airways, since you can usually see enough to get the bougie in when the view is inadequate to pass the tube.

Unfortunately I didnt see s h it on this laryngoscopy.... I didnt have a visual target to pass the bougie towards....so the bougie wasnt useful here.

The bougie is only useful if you have some kind of view of the larynx. No view and its unlikely you can pass the bougie blindly, at least for me.

I am not good at passing a bougie blindly....need at least some view, no matter how small, of the bottom of the aretynoids or whatever.
 
jetproppilot said:
The bougie is only useful if you have some kind of view of the larynx. No view and its unlikely you can pass the bougie blindly .... need at least some view, no matter how small, of the bottom of the aretynoids or whatever.
Click to expand...
cool - thanks for the tip
 
Dr Serenity said:
The distinction that needs to be made here is tension ptx vs. "regular/non-tension" (for lack of a better term) ptx.

In tension pneumos, the trachea will deviate AWAY from the affected lung as more air enters the pleural space with no way for it to escape (hence, need for chest tube).

In a "non-tension" (again, for lack of better term), if the trachea deviates, it will deviate TOWARD the affected lung.

OK, hijack over. We now continue with our regularly-scheduled thread. :thumbup:

-(Not-quite-doctor) Dr. S
Click to expand...

That is not correct. A pneumothorax will never cause deviation towards the affected side.
 
serenity said:
Jet mentioned lung collapse and pneumothorax in the same breath ,that's what confused me.Ofcourse collapse will white out the lung and cause tracheal deviation towards the collapsed lung and vice versa for pneumo.
Click to expand...

By "collapse", are you referring to atelectasis? Sorry if this sounds like a dumb question but I was confused by this post.
 
how can a pneumothorax cause tracheal deviation toward the affected side? although i have read that a nonlesion pneumothorax will cause deviation towards the ipsilateral side.
 
jeesapeesa said:
how can a pneumothorax cause tracheal deviation toward the affected side? although i have read that a nonlesion pneumothorax will cause deviation towards the ipsilateral side.
Click to expand...

I went back through some literature and I didn't find anything about pneumothoraces causing tracheal deviation TOWARD the affected side. Thus, I will agree with gasnewby and Plankton that my earlier post was wrong. Please disregard it. :D
 
Jeesapeesa, Please reread your post--that shiit don't make sense. Somethin' with the words "ipsilateral" and "affected". Regards, ---Zip
 
Dr Serenity said:
I went back through some literature and I didn't find anything about pneumothoraces causing tracheal deviation TOWARD the affected side. Thus, I will agree with gasnewby and Plankton that my earlier post was wrong. Please disregard it. :D
Click to expand...

better to say it here and be corrected than to say it on ICU rounds next year as an intern and have your ass handed to you by a miserable upper level surgery resident. :thumbup:
 
Trisomy13 said:
better to say it here and be corrected than to say it on ICU rounds next year as an intern and have your ass handed to you by a miserable upper level surgery resident. :thumbup:
Click to expand...

Agree with above. :)
 
zippy2u said:
Jeesapeesa, Please reread your post--that shiit don't make sense. Somethin' with the words "ipsilateral" and "affected". Regards, ---Zip
Click to expand...

See dr. serenity's post. :eek: disregard it.
 
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