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DrAlex_76
Forum Guru

Topics: 120
Posts: 410

09/09/08 - 12:07 PM

32 yo man is brought to ED 30 mins after involved in MVC. He was the restrained driver. He is alter and shortness of breath.BP = 80/50 , P =130.m., RR = 30. His trachea is deaviated to the right, absence of breath sounds on the left. JVD and abrasions on the left hemothorax. Which of the following is most likely cause his hypotension ?

A. cardiogenic shock

B. Congestion heart failure

C. Decreased in systemic vascular system

D. Increased in SVR

E. Decreased in veonous return

F. Hypovolemic hypoperfusion

Please give explaination ,

pl

ngaybinhyen
Forum Guru

Topics: 23
Posts: 657

09/09/08 - 01:57 PM

E make sense in

blunt chest trauma
mediastinal shift + unilateral absent breath sound + JVD

==> increased intrathoracic pressure

- it should not be A,B,C,D raised eyebrow

- JVD against F nod

nightflight1945
banned

Topics: 32
Posts: 920

09/09/08 - 11:45 PM

E. Decreased in veonous return
Tension Pneumothorax causes decreased venous return and ...

ngaybinhyen
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09/10/08 - 01:49 PM

Why tension pneumothorax?

DrAlex_76
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Topics: 120
Posts: 410

09/10/08 - 09:19 PM

thats Tension pneum, bro ! clasic one ...hypotension, JVD , shift trachea to opposite side. Also abrasion and decreased breath sounds on same side.

ngaybinhyen
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Topics: 23
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09/10/08 - 10:22 PM

thanks

Actually, it could be hemothorax, rite?

Edited by ngaybinhyen on 09/10/08 - 10:37 PM

nightflight1945
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09/11/08 - 12:17 AM

wasedf
Forum Junior

Topics: 5
Posts: 74

09/14/08 - 01:25 PM

Agree, this is a classic case of Tension pneumothorax. It could also be hemothorax, but usually the trachea shift is not so marked and there is mention of dullness on percussion if the question wants us to make the distinction.

thanks

young_doc
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Topics: 58
Posts: 737

09/16/08 - 09:23 AM

ngaybinhyen wrote:
nod

thanks

Actually, it could be hemothorax, rite?

Even if there was a hemothorax, the answer would still be the same! i.e. decreased venous return.

It's the mechanism here they're looking for. So even if tthe guy was bleeding out into his lungs, it probably wouldn't be enough to cause a hypovolemic state.. But it would be enough to decrease the venous return back to the heart.

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ngaybinhyen
Forum Guru

Topics: 23
Posts: 657

09/16/08 - 09:43 AM

#10

Oh, yeah. That's what i was thinking. I didn't mention the Dx.
MC is pneumothorax

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