armymedic571 Posted May 17, 2010 Posted May 17, 2010 (edited) CH- With our left sided neck hematoma, is there any sub Q air? Eventhough there seems to be good compliance bagging, I would still consider the chest needle decompression. Just a thought.... In the event that it is a hemo... I don't think it would be necessarily beneficial, but would wouldn' t lose anything either.... J Edited May 17, 2010 by armymedic571
chbare Posted May 17, 2010 Author Posted May 17, 2010 No SC air noted, no indications of a pneumo, no indications of a hemo save the vital signs. Needle decompression does not change the situation. Can these findings be explained by the tracheal deviation? Take care, chbare.
speedygodzilla Posted May 17, 2010 Posted May 17, 2010 No SC air noted, no indications of a pneumo, no indications of a hemo save the vital signs. Needle decompression does not change the situation. Can these findings be explained by the tracheal deviation? Take care, chbare. Yes I would think that is possible. If the hematoma is pushing the trachea to the right thus diverting air to the right. Not a great explaination but I think it is quite possible that the hematoma and trachea deviation could be a factor. How about maintaining c-spine but accessing the hematoma and applying constant pressure to decrease its size and impact? I would weight the risk and benifits. If the patient is "stable" the rate quality and depth are adequate I am not sure I would feel comfortable messing with a large hematoma on the neck. If it is impeding on ventilations than I would move on the the constant pressure to the hematoma.
chbare Posted May 17, 2010 Author Posted May 17, 2010 Yes I would think that is possible. If the hematoma is pushing the trachea to the right thus diverting air to the right. Not a great explaination but I think it is quite possible that the hematoma and trachea deviation could be a factor. If the left bronchus was blocked due to the haematoma, then the left side would not rise at all, no? Or, is there a way to explain what you are seeing? Take care, chbare.
speedygodzilla Posted May 17, 2010 Posted May 17, 2010 If the left bronchus was blocked due to the haematoma, then the left side would not rise at all, no? Or, is there a way to explain what you are seeing? Take care, chbare. The left sided hematoma must not be completely blocking the left lung. Just causing a delay in the air arriving to the lung due to the blockage. Maybe try slower than usual squeeze of the BVM giving the lungs time to properly fill together. Messing with the neck in anyway sounds contraindicated to me. This patient is gonna need surgery.
chbare Posted May 17, 2010 Author Posted May 17, 2010 Lets say there is no blockage, just a deviated trachea. Could this along with ET placement alone cause these findings? If so, is there a physical principle that can explain these findings? Take care, chbare.
mobey Posted May 17, 2010 Posted May 17, 2010 I agree on the chest rise.... As long as we have good SP02, EtC02, signs of good perfusion, I'll let the Doc's figure it out. If we start seeing signs of inadequate oxygenation/ventilation (or incorrectible hypotension) I would be pretty quick to needle decompress the left side. Just a side note: If you are ever RSI'ing me ALWAYS use some kind of sedation prior to Sux. It does not take long to dump in 200mcg of Fentanyl.
speedygodzilla Posted May 17, 2010 Posted May 17, 2010 Lets say there is no blockage, just a deviated trachea. Could this along with ET placement alone cause these findings? If so, is there a physical principle that can explain these findings? Take care, chbare. So CEBBS but trachea diviation along with ET placement. I am drawing a blank. Fractured ribs? What does palpation of chest find? Get on the radio with MEDCON I guess and explain findings.
Kiwiology Posted May 18, 2010 Posted May 18, 2010 I don't know, I am not a physician and that is what this patient needs. Rather than not going with the program and gettin a lil crazy lets take the patient to the hospital where they can use all the flash equipment they have to figure it out. Now if you ask for my opinion that is another matter entirely .... my money is on a haemothorax or some kind of ubiquidos chest trauma
chbare Posted May 18, 2010 Author Posted May 18, 2010 (edited) First, I want to emphasise that this is not a critical situation in light of the patients injuries. This is more of an exercise in mental masturbation with all the trauma stuff thrown in as a distraction. Also, this is somewhat of a novel concept; however, I know of at least one case in the literature. There exists a physical concept known as the Coanda effect. It essentially states that in some situations a fluid will have a tendency to attach to a surface and follow the said surface. Fluid in a physical sense can be a gas or a liquid as both have fluid like characteristics when in motion. An easy do at home example of this effect involves a candle and a can of soup. Light the candle and put it in front of the can of soup. Blow a stream of air on the other side of the can. Conventional wisdom says the can should stop the flow of air. However, the air attaches to the surface of the can and contours around it to blow the candle out. In this case, the deviation placed the ETT near or on the right tracheal wall. The flow of air attached to the wall and followed it into the right lung. Then, as the lung filled, the air essentially spilled over into the left lung so to speak. This is what led to the asymmetrical expansion I have a rather bad drawing attached to better view the effect. An art major I am not: In the actual case stude, the provider rotated the ETT by about 90 degrees and was able to resolve the asymmetrical movement problem. I hope you guys enjoyed this one as it was a little different, but still thought provoking hopefully. Take care, chbare. Edited May 18, 2010 by chbare 2
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