Medical Surgical Hemothorax vs Pneumothorax #3

Question

A client is brought into the emergency department with a gunshot wound to the chest. The nurse observes that the chest appears larger on one side and she hears crackling sounds as the client breathes and the client has jugular vein distention. The resident reports there is hyperresonance on percussion. Which action will most likely take place next?

Answers

  1. Placement of a sterile occlusive dressing.
    • Rationale:

      This answer is not correct because placement of a sterile occlusive dressing is used for a sucking chest wound during a pneumothorax to prevent tension pneumothorax. The client is already exhibiting signs of tension pneumothorax.

  2. Needle thoracostomy at the bedside.
    • Rationale:

      This answer is correct because the client is showing signs of a tension pneumothorax and immediate treatment is required. The key finding is the hyperresonance on percussion. A needle thoracostomy at bedside is clinically indicated in this emergent situation to release the trapped air inside the pleural space in order to save the client’s life.

  3. Immediate chest x-ray.
    • Rationale:

      This answer is not correct because there is no time to wait for confirmation. A tension pneumothorax has to be diagnosed and treated immediately at the bedside.

  4. Placement of oxygen with a nonrebreather.
    • Rationale:

      This answer is not correct because it is not indicated since tension pneumothorax rapidly deteriorates the client’s ability to maintain oxygenation. The root cause should be addressed STAT in order to stabilize the client during this life-threatening emergency.

Overview

The client is exhibiting signs of a tension pneumothorax which is a life-threatening medical emergency that requires immediate intervention. Tension pneumothorax should be diagnosed by clinical findings only since there is no time for radiographic confirmation due to the high incidence of fatality.

Explanation

Learning Outcomes

The client is exhibiting signs of a tension pneumothorax which is a life-threatening medical emergency that requires immediate intervention. Tension pneumothorax should be diagnosed by clinical findings only since there is no time for radiographic confirmation due to the high incidence of fatality The key finding is the hyperresonance on percussion. A needle thoracostomy at bedside is clinically indicated in this emergent situation to release the trapped air inside the pleural space in order to save the client’s life. A sterile occlusive dressing is placed over the chest wound to prevent tension pneumothorax. If the client is exhibiting clinical signs of pneumothorax, STAT treatment at the bedside by needle decompression is required to save the client’s life.

Test Taking Tip

Remember with tension pneumothorax, there is no time for clinical confirmation. It is a life-threatening emergency.

Video Rationale