Sunday, February 8, 2009

More Pneumothorax


In medical blogging, I've found that patience is usually rewarded. I had a craving to write about pneumothorax and when Gerald Wallace was crunched by by Andrew Bynum, I jumped all over it. But it turns out that all I had to do was wait a week and a situation would develop in my own practice. I was covering for another surgeon who had a patient in the ICU on the vent. The patient had severe COPD and seemed to suddenly decompensate; low BP, dropping oxygen saturations, etc. So I ordered the usual workup, i.e. CXR, ABG, cardiac enzymes, et al. And the above picture showed up on my home computer. So I hustled into the hospital, slammed in a chest tube and the subsequent CXR made everyone feel more better. (Special thanks to the state trooper who inexplicably didn't pull me over as I zoomed by at 90 MPH on I-271).


8 comments:

OHN said...

I think I am more stunned about the trooper than the patients condition. Ohio troopers site their own mothers :)

rlbates said...

Good work!

Frank Drackman said...

In Ala-bamy the Trooper would have pulled ya over for driving suspiciously slow...and the Drug Sniffin Dog would have gone crazy over your Buckeye Bumper Sticker...

Anonymous said...

If you have time to edumacate a med student... What's going on in that CXR?

is the collapsed lung on the right side (that ghostish looking thing) and is the mediastinum being pushed to the left? I see your tube in the right fifth intercostal space...

Anyway, after hearing your story I have to show you the correct response if you do ever get pulled over:

http://slog.thestranger.com/files/2008/07/GoddamnBatman.jpg

hp123 said...

I have the greatest respect for gen surgeons, but why didn't the intensivists put a chest tube in him when they got this CXR? You know, those people who WORK in ICU, and who knows how to read that textbook CXR clearly showing no lung markings on R?

Anonymous said...

hp123: probably for the same reason I got consulted for suture removal yesterday night. Some people just don't have what it takes to assume any real responsibility for patient care. Perhaps not coincidentally, they also have the shortest residencies.

radinc said...

tension pneumo no less!

Frank Drackman said...

When I did my Intensivist Rotations during Anesthesia residency, I did all my own Chest Tubes, Did all my own Pneumothoraces too...