A 36-year-old man is brought to the emergency department after sustaining multiple stab wounds and blunt trauma to his chest during a gang fight. On arrival, he has severe chest pain that worsens on inspiration and coughs intermittently. He is alert and in moderate respiratory distress. His temperature is 37.0°C (98.6°F), pulse is 110/min, respirations are 24/min, and blood pressure is 85/58 mm Hg. Examination shows jugular venous distension. Breath sounds are decreased on the right and the trachea is deviated to the left. Which of the following is the most likely cause of this patient's hypotension?

Question

A 36-year-old man is brought to the emergency department after sustaining multiple stab wounds and blunt trauma to his chest during a gang fight. On arrival, he has severe chest pain that worsens on inspiration and coughs intermittently. He is alert and in moderate respiratory distress. His temperature is 37.0°C (98.6°F), pulse is 110/min, respirations are 24/min, and blood pressure is 85/58 mm Hg. Examination shows jugular venous distension.  Breath sounds are decreased on the right and the trachea is deviated to the left.  Which of the following is the most likely cause of this patient's hypotension?

Quizplus · Accepted Answer

Eductional Objective: Tension pneumothorax involves progressively increasing intrapleural pressure that leads to contralateral mediastinal shifting (eg, tracheal deviation) and vena cava collapse.  Hypotension, tachycardia, and obstructive shock develop due to decreased venous return to the heart.

A 36-Year-Old Man Is Brought to the Emergency Department After