Emergency case with jugular distension and far breath sounds? - USMLE Forums
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Old 02-09-2011
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Emergency Emergency case with jugular distension and far breath sounds?

Patient involve in motor accident , in Emergency room they find a jugular venous distention , respiration is 30 / min , breath sound are far , there is a pressure difference between two arms , we find also a multiple ribs fracture what is diagnosis?


A- TENSION PNEUMOTHORAX

B- CARDIAC TAMPONADE

C- PLEURAL EFFUSION
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Old 02-09-2011
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Arrow

B) cardiac tamponade
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Old 02-09-2011
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elevated JVP is the classic sign of venous hypertension, so would that be considered Kussmaul's sign?

If so then it'd indicate impaired filling of the right ventricle, therefore i'd think

pericardial effusion
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Old 02-10-2011
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I go with A. Tension pneumothorax.
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Old 02-10-2011
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i am confused between tension pneumothorax and pericardial tamponade

they are similar in presentation .....

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Old 02-10-2011
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I'm also torn between those two, but I think I'd go with tension pneumothorax, assuming that the "far breath sounds" is a unilateral finding.

Is the difference in pulse because of the pressure of the backed up veins on the subclavian arteries? Because the right has both subclavian (innominate) veins running over it but the left only has the left? I understand the difference with dissection or coarctation, but I don't understand it in this case... It would be great if someone could explain this! :sorry:

@PatelMD - doesn't Kussmaul's sign depend on whether JVD increases with inspiration?
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Old 02-10-2011
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Quote:
Originally Posted by Mondoshawan View Post
I'm also torn between those two, but I think I'd go with tension pneumothorax, assuming that the "far breath sounds" is a unilateral finding.

Is the difference in pulse because of the pressure of the backed up veins on the subclavian arteries? Because the right has both subclavian (innominate) veins running over it but the left only has the left? I understand the difference with dissection or coarctation, but I don't understand it in this case... It would be great if someone could explain this! :sorry:

@PatelMD - doesn't Kussmaul's sign depend on whether JVD increases with inspiration?
All the details of the case are skewd,

What made me think of Kussmaul's sign, although not given info:

RR is 30, Normally 12-18, so definately increased.

I correlated this with Jugular Venous Pulsations (bias?), connecting the two is normally seen in Pericardial Effusion

Im not too sure about this one either..
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Old 02-11-2011
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A- TENSION PNEUMOTHORAX But can't think of reason for difference in blood pressure in two arms...
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Id go with A- tension pneumothorax, the tension could account for the difference in the blood pressure, impingement of the subclavian artery on the other side with mediastinal shift, although no side was indicated in the case...

also with multiple rib fracture, which could cause flail chest, and could cause laceration of the lung causing tension pneumothorax...
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