A patient is brought to the Emergency Department with a gunshot wound to the chest. The healthcare professional assesses an abnormality involving a pleural rupture that acts as a one-way valve, permitting air to enter on inspiration but preventing its escape by closing during expiration. What action by the healthcare professional is the priority?
A)Draw arterial blood gasses.
B)Assist with a chest tube insertion.
C)Give the patient low-flow oxygen.
D)Assess for clubbing of fingernails.

Question

Quizplus · Accepted Answer

In a tension pneumothorax, the site of pleural rupture acts as a one-way valve, permitting air to enter on inspiration but preventing its escape by closing up during expiration. As more and more air enters the pleural space, air pressure in the pneumothorax begins to exceed barometric pressure. Air pressure in the pleural space pushes against the already recoiled lung, causing compression atelectasis, and against the mediastinum, compressing and displacing the heart, great vessels, and trachea. This is an emergency condition requiring chest tube insertion or immediate needle decompression. Arterial blood gas results will not change the treatment plan. This patient may need oxygen if definitive treatment is delayed, but it would need to be high-flow oxygen. Clubbing of fingernails occurs in chronic hypoxemic conditions. The professional should assist with immediate needle decompression or chest tube insertion.

A Patient Is Brought to the Emergency Department with a Gunshot