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Old 09-29-2015
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Default Remembered USMLE Question 318

A 35 year-old female presents to the ER with a complain of severe chest pain and shortness of breath. She had similar episodes in the past but didn't feel that much of pain. She evaluates her pain as 10 out of 10. Her past medical history includes Systemic Lupus Erythematosus ( SLE ) and pulmonary fibrosis. She takes a lot of medications but she only remember cortisone as one of them. Her CT scan is shown above on the diagram.
What is the very first step in management of this patient?
A- Emergency needle decompression
B- Place the patient on 100% oxygen
C- Insert a thoracostomy tube.
D- Refer to surgical department
Answer: http://medical-usmle.com/?p=318
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Old 09-30-2015
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Default

Answer is B:

By breathing 100% oxygen instead of air, alvelolar pressure of nitrogen falls, and nitrogen is gradually washed out of tissue and oxygen is taken up by vascular system. This causes substantial gradient between tissue capillary and the pneumothorax space, this results in multifold increase in absorption from pleural space. It is recommended that hospitalized patient with any type of pneumothorax who is not subjected to aspiration or tube thoracostomy should be treated with supplemental oxygen at high concentration.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2700561/
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