Pneumothorax
Patient Presentation:
E.S. is a 26-year-old male who was admitted from the ER to the Intermediate Care Unit for closer monitoring s/p motor vehicle accident. The patient arrived on 4L nasal cannula with 98% oxygen saturation. The patient complained of 9/10 pain to his left chest wall. Upon auscultation the patient had audible breath sounds on the right chest but absent sounds on the left. Palpation of the left chest relieved crepitus. Vital signs were as followed: BP 154/92, HR 112, RR 26, O2 98%, temp 97.3 orally.
Differential diagnosis:
Pneumonia, COPD, bacterial infection, pneumothorax
Diagnosis:
The initial portable chest x-ray in the ER showed a small pneumothorax that appeared would resolve on its own. Twelve hours later in the Intermediate Care Unit the patient continued to have shortness of breath and pain. A follow-up AP (anterior-posterior) and lateral chest x-ray was ordered. It showed the pneumothorax had significantly increased in size. It was determined the patient required a chest tube.
Treatment:
At the bedside the Nurse Practitioner numbed the area and placed a 28-French chest tube into the patient’s left 4th intercostal space. After the chest tube was sutured in place, a portable chest x-ray confirmed its placement. It was then attached to wall suction. The output was recorded every 12 hours. The patient was encouraged to deep breathe, cough, and to use the incentive spirometer in order prevent infection.
Outcome:
E.S. was weaned to room air. Over time the chest tube output declined and became more serous. It remained in place for four days until it was discontinued at the bedside by the Nurse Practitioner. The final chest x-ray showed the pneumothorax had resolved. E.S. was discharged from the hospital six days after the accident with no further complications.