Case Study: 25-years old college student as involved in a very heavy car acciden
ID: 3524853 • Letter: C
Question
Case Study:
25-years old college student as involved in a very heavy car accident. Arriving at the scene, the EMT personnel observe that: she was cyanotic and apneic (not breathing); her pulse was fast and thread, her head was tilt at peculiar angle as if she is having fracture at C2 vertebra.
Questions:
1. What is the connection between her head position and her cessation of breathing?
2. Explain to your best her cyanosis.
3. What is pneumothorax and why would in cause of R lung to collapse? Why not the left one?
4. Doctor inserts a chest tube into the R intrapleural cavity and hooks it up to suction. How might this alleviate the pneumothorax?
Explanation / Answer
1. Head injury and fracture at C2 vertebra would have resulted in inflammation and accumulation of fluids obstructing the airways (physical obstruction of the airways), release of autocoids would have further aggreviated the condition causing bronchospasm and ultimately resulted in cessation of breathing (as evident from cyanosis, no breathing rate and fast pulse rate). This condition can be termed as Breathing emergency where the EMT personnel should provide oxygen with positive pressure to facilitate breathing.
As there is cessation of breathing due to head injury and peculiar tilt of head is clearly seen, it is recommended that the head should be retilted at an angles less than 80 degrees or more than 100 degrees for ensuring better airway and provide the supportive oxygen treatment or cardio pulmonary resuscitation basing on the symptoms of the patient.
2. Cyanosis can be described as the diffused bluish discoloration of skin (and mucus membranes). It is due to the presence of excessive amounts of reduced Hemoglobin the blood. When there is 5-7g/dl of reduced Hemoglobin in the blood, it results in cyanosis and can be markedly seen in certain regions where skin is thin ex. lips, cheeks, ear lobes, nose, fingertips etc.
In the given condition as there is reduced oxygen tension (due to choking by head injury), hemoglobin is replaced by carbon dioxide which is produced from the metabolism of cells, creating reduced form of Hemoglobin. DIsruption of oxygenation in the lungs would have resulted in accumulation of reduced form of Hemoglobin (Arterial hypoxia and stagnant hypoxia) resulting in cyanosis.
3. Pneumothorax can be defined as a condition where there is presence of air in the pleural space which makes the intrapleural pressure positive (which is negative in healthy individuals) causing the lungs to collapse.
As the patient in the given case met with a heavy accident, damage to the chest wall would resulted in Open pneumothorax or tension pneumothorax.
Open pneumothorax: The injury results in open communication between pleural cavity and exterior. As a result, the air enters the pleural cavity during inspiration and comes out during expiration. This causes collapse of lungs leading to hypoxia, hypercapnea, dyspnea, cyanosis and asphyxia
Tension pneumothorax: During the injury, the tissues over the injury may act as a fluttering valve which permits entrance of air into pleural cavity that permits entry of air inot pleural cavity but prevent exit of air during expiration which increases intrapleural pressure drastically than the atmospheric pressure. This condition is very fatal and can lead to collapse of entire lung.
In the given condition, there are chances that Spontaneous Pneumothorax would have occured due to rupture of visceral pleura whch act as check valve as explained before causing right lung to collapse. On the other hand, right lung has higher volume, more weight and more broader than the left lung with three lobes. Apex of the lung is more prone for pneumothorax, right lung having high volume and ascending more past the clavicle makes it more susceptible for injury than the left lung.
Left lung is more recessed due to the jutting out of the heart and has less chances of pneumothorax
4. As the given case is suspected with either Sponataneous or Traumatic pneumothorax, chest tube helps in removing excess air in the pleural space, restoring the imbalance of pleural pressure (restoring negative pleural pressure), re expansion and prevention of collapse of lungs, and drainage of excess entrapped air, fluid and/ or blood helps in alleviating the pneumothorax.
Care should be taken that water seal chamber of chest tube is filled with sterile water, and the level should be clearly monitored.