Step I tension pneumo vs spontaneous

[Direct Laryngoscopy]

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In both cases does the trachea deviate away from the collapse or does the trachea deviate to the side of the spontaneous bleb. There was a question like this on the nbme (one of the choices was away from spontaneous bleb), goljan (in his book) says that In tension its away and spontaneous it toward the collapse and first aid doesn't really differentiate between the two.

Much appreciated!

 

[arthrodisiac]

ive seen the same ambiguity within textbooks, but from what i remember, its away for tension and towards for spontaneous.

 

[lfesiam]

In both cases does the trachea deviate away from the collapse or does the trachea deviate to the side of the spontaneous bleb. There was a question like this on the nbme (one of the choices was away from spontaneous bleb), goljan (in his book) says that In tension its away and spontaneous it toward the collapse and first aid doesn't really differentiate between the two.

Much appreciated!

Tension = increase pressure, push trachea away (communication with outside atm pressure)
Spontaneous = negative pressure, suck the trachea toward, (there's no communication with the outside atm pressure.)


correct me if i'm wrong.

 

[Hernandez]

correct me if i'm wrong.

You are correct.

 

[Army DOC DO]

Tension = increase pressure, push trachea away (communication with outside atm pressure)
Spontaneous = negative pressure, suck the trachea toward, (there's no communication with the outside atm pressure.)


correct me if i'm wrong.

ahh close..(just an issue with what one has outside atm pressure).
Tension Pneumo: means you have a penetrating trauma, like a knife fight,gun shot, you get a flap and as you breath (diaphram goes down increasing negative intrathoracic pressure) air comes into the plueral cavity but can't go back through the flap, it seals itself building up intra thoracic pressure, and this causes the trachea to deaviate away from the affected side and the diaphram to be depressed on that side and stay down. and compression atelectasis occurs
Spontaneous Pneumo: from a ruptured bleb, get a hole that has no flap, and thus communicates with the atm through the lung and out the trachea etc. and you loose theability to draw negative intrathoracic pressure, and this causes some or all of the lung to colapse and you get trachea to deviate to that side, and the diaphram elevates because there is No "pressure" of air filled lungs pressing down on the diaphram. (lung does not ventilate on that side very well, loss of negative intrathoracice pressure to draw air into the lung.

 

[blz]

ahh close..(just an issue with what one has outside atm pressure).
Tension Pneumo: means you have a penetrating trauma, like a knife fight,gun shot, you get a flap and as you breath (diaphram goes down increasing negative intrathoracic pressure) air comes into the plueral cavity but can't go back through the flap, it seals itself building up intra thoracic pressure, and this causes the trachea to deaviate away from the affected side and the diaphram to be depressed on that side and stay down. and compression atelectasis occurs
Spontaneous Pneumo: from a ruptured bleb, get a hole that has no flap, and thus communicates with the atm through the lung and out the trachea etc. and you loose theability to draw negative intrathoracic pressure, and this causes some or all of the lung to colapse and you get trachea to deviate to that side, and the diaphram elevates because there is No "pressure" of air filled lungs pressing down on the diaphram. (lung does not ventilate on that side very well, loss of negative intrathoracice pressure to draw air into the lung.

lol...someone has been listening to goljan.

 

[You'reCrazy]

lol...someone has been listening to goljan.

i knew that sounded familiar........well done

 

[mohaven]

In both cases does the trachea deviate away from the collapse or does the trachea deviate to the side of the spontaneous bleb. There was a question like this on the nbme (one of the choices was away from spontaneous bleb), goljan (in his book) says that In tension its away and spontaneous it toward the collapse and first aid doesn't really differentiate between the two.

Much appreciated!

All of the above explanations are on the spot. I would just like to add that in the case of a penetrating wound (foreign body such as knife is not present; if present the following CANNOT be done as the foreign body may be stopping a massive bleed and can only be removed in the operation theater) where the parameds suspect a case of tension pneumothorax they manually adjust the flap and put a square covering on the wound. They tape the wound from three sides leaving one side of the square covering untaped. What does this accomplish? When negative intrathoracic pressure builds up in the thorax the cloth covers the wound preventing air from entering the pleural cavity. Upon exhalation the untaped side fo the square cloth allows aire to seep out. A very efficient way to buy the patient type so that they don't go into shock. This is done as the patient is being scooped and transported so that no time is wasted. I thought that was pretty cool.

 

[SOUNDMAN]

lol...someone has been listening to goljan.

Beat me to it!

 

[Army DOC DO]

lol...someone has been listening to goljan.

well YAAAAAA!!!!! 😀😀

 

[suscsicisi2000]

Well stated, just like with our little friend... George Clooney in Three Kings