An 18-year-old man is brought into the hospital after being stabbed in
the right upper arm with an icepick. He complains of pain in the arm
but otherwise seems to be uninjured. You roll up his sleeve to examine
the arm and see entrance and exit sites. Since he has good pulses in
the extremities, you think that he is stable. While you are doing some
paperwork, he becomes very short of breath and hypotensive. What
happened?
If you had removed his shirt, you would have seen that the puncture
went through the arm and into the right chest. A pneumothorax developed.
Because he was young and healthy, he was able to tolerate it
until the pressure built up in the chest cavity. At that point he developed
a tension pneumothorax—a true emergency!
Only when the patient is stable from the perspective of the ABCs can you undertake
specific evaluation of more obvious injuries.
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