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Old 10-20-2011
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Default Cardiology

A 40-year-old man is admitted to the hospital electively for placement of a pacemaker for symptomatic bradycardia. Ten hours after the procedure, he begins complaining of shortness of breath. He has no other medical issues and is not taking any medications. His blood pressure is 85/50 mm Hg and pulse is 60/min. Electrocardiogram reveals a paced rhythm. He has decreased left sided breath sounds. Stat chest x-ray is notable for a hyperlucent left lung. What is the most appropriate next step in this patientís management?
A. Intubate the patient
B. Place a chest tube
C. Perform a thoracotomy
D. Perform cardioversion
E. Send him for a CT scan
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  #2  
Old 10-20-2011
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B. Place a chest tube
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  #3  
Old 10-20-2011
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Chest tube to underwater seal , location high in chest
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Old 10-20-2011
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B. Place a chest tube
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Old 10-20-2011
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Default Answer

The correct answer is B. This patient underwent a procedure that possibly resulted in the catheter rupturing the vein and impinging on the lung, thus causing a pneumothorax. His chest x-ray shows lucency, which indicates that there are no vascular signs, an indication of a collapsed lung. The absent breath sounds indicate that his left lung is collapsed. Immediate chest tube placement is needed to reinflate the lung.

At this time, chest tube placement is more important. Intubation will create positive pressure and worsen the pneumothorax (choice A).

Performing a thoracotomy (choice C) will be an unnecessarily invasive approach.

Performing cardioversion (choice D) might be indicated if this patient were hemodynamically unstable. Correcting the pneumothorax should resolve the hypotension
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Old 10-20-2011
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B. Place a chest tube
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