Description of Event or Problem · 1
PT PRESENTED WITH COMPLAINT OF DYSPOEA OF 1 HR. EXAMINATION FINDINGS INCLUDED SHORTNESS OF BREATH, APYREXIC. CXR REVEALED RIGHT BASAL PNEUMOTHORAX. RIGHT LOWER LOBE COLLAPSED FULLY, RIGHT UPPER LOBE TETHERED. DECIDED TO PLACE PLEUROCATH AND WILL NEED INTERCOSTAL CHEST DRAIN IF PNEUMOTHORAX FAILS TO RESOLVE. THE PLEUROCATH WAS INSERTED, UNDERWATER SEAL DRAIN ATTACHED AND NOTED TO BE BUBBLING AND OSCILLATING. CXR PERFORMED AT 14.10 HRS. INTERCOSTAL DRAIN OBSERVATION CHART NOTED AT 14.15 HRS: OSCILLATING, NO AIR LEAKS, NO DRAINAGE OF FLUID. AT 17.10 HRS, PT. WAS TRANSFERRED. AT 19.00 HRS, OBSERVATIONS WERE STABLE, INTERCOSTAL OBSERVATION CHART RECORDINGS UNCHANGED. CODE BLUE WAS CALLED AT 0.100 HRS. PT UNRESPONSIVE AND 400ML OF DRAINAGE WAS NOTED FROM INTERCOSTAL TUBE. THE PT HAD EMD, RESPONDED TO RESUSCITATION. URGENT MOBILE CXR ON WARD SUGGESTED AN ENLARGED HEART AND MEDIASTINUM, COMPARED TO PREVIOUS CXR. NO PNEUMOTHORAX OR HEMOTHORAX. RIGHT SIDED SUBCUTANEOUS EMPHYSEMA WAS NOTED TOGETHER WITH HYPOTENSION. A TRANSTHORACIC ECHO WAS PERFORMED. PT REVIEWED BY CARDIOTHORACIC TEAM AND TRANSFERRED TO OPERATION FOR DEFINITIVE CARE AND SUBSEQUENT ADMISSION TO ICU.