A motor vehicle accident has resulted in critical injury for the driver of the car. The driver has hit the steering wheel with his chest and fractured his sternum and some ribs
Which of the following manifestations would lead the staff to suspect the driver has developed a tension pneumothorax? Select all that apply.
A) Audible friction rub over the affected lung
B) Mediastinal shift of the trachea toward one side
C) Marked peripheral edema in lower limbs and ascites
D) Atrial fibrillation noted on ECG printout
E) Subcutaneous emphysema palpated in the upper chest/neck region
Ans: B, E
Feedback:
With tension pneumothorax, the structures in the mediastinal space shift toward the opposite side of the chest. There may be distention of the neck veins, subcutaneous emphysema (i.e., presence of air in the subcutaneous tissues of the chest and neck), and clinical signs of shock. Pneumothoraces do not typically cause a friction rub or dysrhythmias. Marked peripheral edema is associated with right-sided heart failure.
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