CLINICAL SCENARIO CASE:
While working as a private paramedic for high risk events at a New Year’s Eve Event a 28 year old male was found in the bathroom with a penetrating stab wound to the left side of his torso. On arrival, security had placed him in the lateral position on his right side. He was immediately rolled onto his left side after a quick primary survey and DRABC was performed he was found to be suffering a sucking chest wound on his right side with no other significant wounds found. Patient preferred to be sitting up, and was therefore sat up with his right side slightly lower than his left.
Patient was dyspnoeic and short of breath, tachycardiac, low oxygen saturation and hypotensive. Patient’s airway was clear and was administered high flow oxygen. On assessment of breathing patient was found to have a possible tension pneumothorax which was hard to attain due to the ongoing loud music. The patient’s chest wound was dressed by the partner using a one way valve technique (three sided taped dressing) while a needle decompression using a 12 gauge cannula inserted into the 2nd intercostal space, mid-clavicular was performed. It was noted that air was expelled and relief of the tension pneumothorax was confirmed. He also some bruising to his forehead head and a bleeding nose with no other injuries found. Intravenous access was gained and patient was put on normal saline TKVO (to keep vein open) and administered 2.5mg Morphine IV titrated for pain. Patient was now GCS (Glasgow coma scale) 15 and stabilised with ongoing SOB and pain. Patient was now continually monitored and interventions were rechecked until state ambulance service arrived. Patient had history of MDMA intake, alcohol intake and anti-depressant intake for depression, but no toxidromes or significant overdose symptoms were noted. The Patient had history of depression, no known allergies, no diabetes, and no history of epilepsy. Patient was transported to nearest trauma center code 1.
Differential diagnosis was a penetrating wound to the right side with pleural cavity penetration leading to tension pneumothorax.
Post diagnosis and treatment information was unattainable.
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