41 year old male. Motor vehicle accident 30 minutes ago. Driver, no airbag, bent steering wheel. Alert complaining of chest pain.
Describe and interpret this CXR
CHEST X-RAY INTERPRETATION
There is a left pneumothorax with mediastinal shift suggesting a tension. No obvious rib fracture(s).
This needs immediate recognition and a needle decompression.
Studies suggest that between 10-20% of the population may have a chest wall thickness greater than the length of a 14 or 16G cannula in the (classic) 2nd intercostal space, mid clavicular line.
If you can’t access the pleural space here then go for the 5th intercostal space, anterior to the mid axillary line where there is no pectoral muscle to venture across. If thickness of adipose tissue is a problem – you will need to perform a blunt dissection – just use your finger – ‘a finger thoracostomy’.