Spontaneous Pneumothorax Case 3
A 20-year-old female asthmatic arrives by ambulance complaining of sudden onset of breathlessness and right sided pleuritic pain. She has had pneumothoraces on the right side in the past and has had video assisted thorascopic surgery (VATS) to prevent further episodes. The following is seen:
- Pulse is 114 and regular
- BP is 110/80
- Respiratory rate is 26
- O2 sats are 94% on 15 litres per minute of oxygen
- PEFR is about 10% below normal
There is reduced air entry on the right side compared to the left but you can hear no crackles or wheeze. The trachea is central, there is no neck vein distension and heart sounds are normal. You administer high-flow oxygen and move the patient to the resuscitation room for a chest x-ray.
The chest radiograph (shown right) confirms that this is a tension pneumothorax (increased rib spaces and flattened hemi-diaphragm). There is also subtle mediastinal shift but no tracheal deviation. Her condition remains stable.