Interview Question for an EMT postion

[vcfd35s]

I had a question for the board that came up during an interview for an EMT position. A pt. presenting with a Tension Pheumo Thorax will display all of the following signs/symptoms EXCPET: A. Respitory distress B. JVD C.Tracheal Deviation or D. Ausculated Wheezes.

My answer was C..Tracheal Deviation. I chose C because Tension Phuemo Thorax is a air trapped in the chest as a result of a punctured lung, thus you would have signs of A,B,orD. Am i correct in my answer?

Before posting I looked in my book and I couldnt find anything related to Tracheal Deviation and what causes it. I looked up JVD and read that it was a result of the blood build-up in the veins as a result of the heart not pumping properly. If anyone could clarify these conditions for me at the EMT level and how we can treat these i would really appreciate. Looking at my scope, I cannot find any treatment (besides ABCs, and O2) that would be necessary in the field for JVD, Tracheal Deviation, or Tension Pheumo Thorax.

Thanks in advance for the knowledge.

[EMS49393]

The correct answer is D. Auscultated wheezes. You will hear wheezes in a patient with bronchoconstriction, inflammation, etc. Often this is a finding in an asthmatic or COPD patient.

You might see tracheal deviation in a patient with a tension pneumothorax, although it is generally a late finding. When air is trapped in the thorax and the lung is unable to expand, you could see a shift of the trachea to the opposite side of the "collapsed lung." The pressure in the chest cavity is causing the shift to the unaffected side. As a BLS provider all you can do is provide 100% O2 and treat them with diesel. A person with a tension pneumo needs a decompression, which is performed paramedics, and then, most likely a chest tube.

Hope that helps you! Good luck.

[Ridryder 911]

Maybe pictures will help, if you notice the right side is dark (air/blood) and how the heart & lung has been pushed over.. you will see that the trachea (outline in white) has deviated over as well... this is a severe tension hemo/pneumo.. * p.s. the patient only complained of sh.o.b...

(go figure!)

[Jon_E]

Ok bud, first of all its Pnuemo, not Phuemo. . .pnuemo as in pneumatic or relating to air and stuff ya follow??

I'm 99.999% sure that the correct answer is D. wheezes, although in theory there could be wheezes present also. . .but that is the least of your worries my friend. So, youre right, a tension pnuemothorax is air trapped in the chest as a result of a punctured lung. but think about it, there is a hole in the lung, so any air that you breathe in, is going to go down the trachea, into the lungs, and out the hole. where does it go then? it goes into the pleural cavity of the chest, or the lining between the outside of your lungs, and the inside of your ribs. ever watch the movie "3 Kings" with Ice cube, george clooney, and mark whatever his name is? very good illustration of a pneumothorax there. anyway the air in the pleural space begins to compress the lung with every breath you take, why you ask?, because everytime you breathe in, the pleural space fills with more air, and there is less room for you lung to inflate. . .thats why as an early treatment, you use an occlusive dressing. . .with a tension pnuemo, pretty much the entire side of the chest, (on the inside) has filled with air, your lung now looks like a limp condom. as a result the other lung is now the only one able to inflate, your trachea deviates to the side of the good lung, the entire mediastinum is pushed over by this pressure build up. .compressing your heart, causing JVD. The Tx for this @ the EMT level with all of those Signs/Sx? Uh i dunno. . .prayer. . .profanity. . .incontinence. . .just jokin, the patient needs a needle de-compression and ultimatley a chest tube. . .so better hope u got a Paramedic or an ER with a MD close by or the patient is toast. Tracheal deviation is a late sign. . .anyway a little long winded, but i'm bored/snowed in @ work with no calls. so let me know if ya have more questions. . .be glad to answer for the next 18 hours if I know the answer. . .Jon. emt-p

[BushyFromOz]

Nice picture rid! :thumbleft:

[bbbrammer]

We can always count on Rid to be informative and thorough. I got to admit though, it was a nice attempt at trying to use your A & P to reason out the answer.

[MTNMANMEDIC]

Great Lord.

The question was taken directly from the ITLS final exam for basic providers.

The question should read how do you transport such a patient ?

What treatment should you provide such a patient ?

Is the agency you are applying to a 911 transport agency or a cot jockey nursing home go and get'em type of agency ?

[vcfd35s]

Thanks alot guys for the words of knowledge. That picture really helped me visual the actual problem.

And no the agency I am applying with is not a nursing home scoop and go, but rather a BLS 911 company that runs with county fire.

Thanks again guys!!

[rocketjaw]

I thought jugular vein distention occured when the right side of the heart got backed up (rt side CHF) and blood got backed up into the jugular (correct me if im wrong.) How would a pneumothorax cause that? Will a pneumo cause the right side of the heart to fail pumping blood?

[kelly_isham]

Rocketjaw-

A tension neumothorax would apply pressure to the entire heart and would back blood up into the venous system as well as the lungs, you would have signs of both left and right hearted heart failure.

AK Kidd