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DarbyC
06-20-2018, 06:16 PM
So I am not 'wedded' to this idea, if someone has a more interesting idea. My MMC is wheelchair bound at the moment. He is mugged on a public street. The attack is violent, and he is thrown from the chair. The thief tries to grab his wallet and then viciously kicks MMC in the ribs several times when MMC tussles with him. A nurse comes to his aid. MMC is having problems breathing (I've got a list of symptoms to use), and she quickly diagnoses tension pneumo. No ambulance in sight, she needs to administer immediately emergency aid. What does she need from passersby and how does she do it?

(basic set up: the nurse arranged for this attack to occur (she's actually the villain) It's just by luck that the hired thief was so enthusiastic that he caused a life-threatening medical event to occur, offering the nurse the chance to appear even more of a hero.)

Thanks in advance!

cornflake
06-20-2018, 08:19 PM
Heh, there's a scene in that Reese Witherspoon/Mark Ruffalo romcom... something about Heaven ... in which they treat a person with it in a restaurant.

Though if they're in a city, seems like a much better idea to call 911 for an ambulance.

neandermagnon
06-20-2018, 08:43 PM
A credit or debit card (or similar plastic card) can be used to stop air getting in through a puncture wound in the chest that's causing a pneumothorax. I don't know if that helps or not because I'm not sure what the tension part of tension pneumothorax refers to. This just prevents more air getting into the chest wall by sealing the puncture wound. It doesn't help in terms of getting the air out but can stop further deterioration. This is something I've seen recommended for first aiders, i.e. before paramedics get there. Obviously the paramedics can do more once they arrive.

MaeZe
06-20-2018, 09:08 PM
A credit or debit card (or similar plastic card) can be used to stop air getting in through a puncture wound in the chest that's causing a pneumothorax. I don't know if that helps or not because I'm not sure what the tension part of tension pneumothorax refers to. This just prevents more air getting into the chest wall by sealing the puncture wound. It doesn't help in terms of getting the air out but can stop further deterioration. This is something I've seen recommended for first aiders, i.e. before paramedics get there. Obviously the paramedics can do more once they arrive.

A tension pneumothorax can occur with internal injuries, an external puncture is not needed.

I can't imagine using a credit card, it's too stiff.

From Wiki and the typical thing you see in the movies where MacGyver gets a pen and a balloon to fix it:
The Asherman seal is a specially designed device that adheres to the chest wall and, through a valve-like mechanism, allows air to escape but not to enter the chest.[35]

neandermagnon
06-20-2018, 11:42 PM
A tension pneumothorax can occur with internal injuries, an external puncture is not needed.

I can't imagine using a credit card, it's too stiff.

From Wiki and the typical thing you see in the movies where MacGyver gets a pen and a balloon to fix it:

Thanks for the info :Thumbs:

MichaelC
06-22-2018, 01:46 AM
A tension pneumothorax is caused by air in the space between the lung and the plueral cavity and does not necessarily involve a hole or opening in the skin. If you have a hole or bleeding in the space it's a hemopneumothorax. The proper emergency treatment for a tension pneumothorax is placing a needle (in the movies and books people use a hollow pen) into the chest cavity in the 2nd intercostal space (between the 2nd and 3rd ribs), mid-clavicular line. Note that this will relieve a tension pneumothorax but not a hemopneumothrax. For the latter, the nurse would need to insert a chest tube under positive pressure, something she would not be able to do in a sidewalk setting.

P.K. Torrens
06-23-2018, 11:26 AM
A tension pneumothorax is not easy to diagnose... at all.

I am wondering how a nurse (who typically aren't train to make diagnoses) would diagnose that. This is really far-fetched. Go for a stab wound or something simple.

P.K. Torrens
06-24-2018, 11:11 AM
I certainly didn't mean to imply that a nurse's response would be:
"Gee, the guy is having trouble breathing".

I've worked in NZ, Aus and UK, and in those countries only nurse practitioners are trained to make complex diagnoses. Nurse practitioners make up a very small portion of registered nurses, and I think it's important to make this distinction so that the OP can make the scenario more realistic (as I think that's the goal the OP has in mind). I still think it would be fair to say that a nurse without advanced training (i.e. without a nurse practitioner qualification with a focus on emergency medicine) would have difficulty making that diagnosis. As would a primary care/family doctor, paediatrician etc. as they simply don't have the training.

Excluding nurse practitioners, one of the defining differences between a nurse and a doctor is the formulation of a diagnosis, no? There are certain differences between the two professions that are complimentary. For example, doctors have no idea how to draw up and administer medicines because it's not part of their training. I don't think that's an old-fashioned idea - it's the reason we have the two professions. I would love to know if you think I'm wrong about this though!

That aside, the question here was regarding a tension pneumothorax, specifically, which can be a difficult diagnosis to make even in a well-equipped emergency department setting. So, I think making it on a sidewalk would be hard.

PS that list is super-vague. A tension PTx would come in under the "mode of breathing ineffective" umbrella but I've never heard it described that way. The issue in a tension PTx is that air can enter the hemithorax but can't exit. So you get a mass effect, compressing the great vessels leading to cardiorespiratory compromise.


What country are you in?

Technically neither a nurse nor a doctor could make that diagnosis without an X-ray or tapping the pleural space to see if blood or air were there. Both professions are capable of suspecting a deflated lung on one side.

In the US nurses diagnose a lot of things. In this case we look at a different aspect but one doesn't just say, "Gee, the guy is having trouble breathing". You would note air was only going in one lung. Once that is determined there are only a couple things that would cause it.

Nanda Nursing Diagnosis List (http://www.nandanursingdiagnosislist.org/)

Sorry, I get my hackles up when people have old fashioned ideas about nursing. ;)

Cath
06-25-2018, 11:53 PM
Let's try this again - and please do try to respect that different people and different countries might have different experiences. training, and opinions.

Snitchcat
06-27-2018, 08:59 AM
Would it be helpful to narrow the original question down to a particular State / region?