标题: An unexpected case of difficulty in ventilation [打印本页] 作者: shenxiu2 时间: 2010-3-8 16:27 标题: An unexpected case of difficulty in ventilation 37 year old man , 70 Kg .Smoker.No medical problem . Had a motorvehicle accident at 1am this morning. Sustained right 4th to 7th Ribs fractures, and right lung contusion.He had # right clavicle , # right index finger & little finger, # left thumb and laceration wound at the right elbow. Chest X-rays did not show obvious finding except for multiple ribs #. ECG was normal .Blood test results were essentially normal .Patient was alert , talking rationally.
He was scheduled for open reduction & internal fixation of right clavicle, right fingers, left thumb & toilet & suturing of the laceration wound at the right elbow at 8 pm today.
He was given general anesthesia .
Induction : IV Sodium Thiopentone 300mg, IV Rocuronium 50 mg , IV Morphine 10 mg .
After laryngoscopy , larynx with vocal cords was seen & endotracheal tube size 8mm was inserted into the larynx.
After intubation , it was found that there was difficulty in ventilating , there was tightness at the reservoir bag, the ETCO2 monitor showed no waveform . Meanwhile the SpO2 had dropped to 80%.Heart rate was 44/min. Blood Pressure was 200/ 105mmHg.
1.What could have happened?
2.How would you manage this problem?作者: 心超 时间: 2010-3-8 21:35 回复 1#shenxiu2
There was no breath sounds on both sides of the chest.
We diagnosed a right sided tension pneumothorax causing a mediastinal shift to the left ( therefore the breathsounds on the left side was also not heard ). In view of the multiple rib # on the right side.
A 16G Intravenous cannula was inserted into the 2nd intercostal space at the midclavicular line .
The SPO2 slowly improved to 92% , EtCO2 appeared on the monitor . and there was breath sound heard on auscultation .
A chest drain was inserted at the right 4th intercostal space. The SPO2 improved to 99% , air entry equal on both sides. The patient was put on ventilator (IPPV).The surgery proceeded and patient was extubated well .