A 50s M is bib ems after crashing his car into a house. He was intubated in the field. On arrival, he has a 6.0 ETT, +BS bilaterally, O2 sat is 100% on 100%. A cxr is done. What should we do next?
Field intubation
Jacobi / Montefiore Emergency Medicine Residency
white out of right lung with trachea pulled over to right side (in the face of trauma):
A large hemothorax or pleural effusion or pneumothorax would push the trachea away.
Left mainstem intubation would cause right hemithorax collapse and white out with trachea being pulled over to right side but in this case the ETT is high (above the clavicles) and needs to be pushed down
Pt with pneumonectomy could have this picture
Alternatively,pt could have large mucus plug blocking right mainstem and causing atelectasis and collapse of lung.
you could try suctioning the pt
or maybe has a piece of food blocking right mainstem; you could take a machidascope or a long ambuscope and see what you find
could be pneumonectomy, but you wouldn’t have b/l BS on exam?
bc doesn’t look like a hemo or pneumo bc would expect the mediastinum to be shifted the other way
the xray looks like pneumonectomy with the white out and the trachea deviated the same way, wonderingif the breath sounds are just misheard or referred?
I never trust when people say b/l breath sounds. You can hear breath sounds on both sides but what you want to know is does it sound different.
Since there is shifting towards the lesion this has to be atelectasis or removed lung like a pneumonectomy. Only thing I can think of in this case that would of caused atelectasis would be a contralateral PNX (which we dont see), right mainstem of the ET tube (which we should see on the X ray), mucus plug, or aspirated food bolus.