After 12 minutes the ambulance has arrived. Honza, quite disturbed, tries to describe Michal's condition meanwhile Michal is still leaning against the tree and his breathing is getting worse.
Now you are a doctor of EMS. You perform basic physical examination according to the ABCDE procedure. In the meantime, our emergency team secures an IV line. How do we evaluate Michal’s condition based on the examination?
Clinical symptoms of tension pneumothorax includes dyspnoea, cyanosis, tachypnoea, tachycardia, subcutaneous emphysema, hypotension, impaired breathing and hyperresonant percussion over the affected lung.
Symptoms such as jugular veins distention, deviation of the trachea to the unaffected side, changes in ECG (manifestations of obstructive shock) usually develops later.
There could be similar symptoms in case of cardiac tamponade. However, this condition is more likely to occur in severe chest trauma. In addition, when listening to the lungs we found a weakened breathing on the right side. This leads us to another life-threatening condition.
Internal bleeding can not be excluded at this time. However, based on the physical examination and measured values we should think of another life-threatening condition.
Findings during physical examination.
A - free airways.
B - impaired breathing on the right, tachypnoea, hyperresonant percussion on the right.
C - tachycardia, hypotension, pale skin color, capillary return - 2 s, echoes limited, no murmur.
D - GCS 15, isocoric pupils.
E - abrasions on the right side of the chest and on the limbs, palpable abdomen, no resistance present, subcutaneous emphysema in the neck area.
A - No allergies
M - does not take any medicatiofn.
P - does not suffer from any other diseases.
L - last had a small snack 2 hours ago.
E - breathing problems after falling on a bike.