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| This is a right-sided pneumothorax. The lung has collapsed down, leaving only free space in the patient's right chest cavity |
"Ahh, doctor, fuck! Please, doctor, please."
The resident jammed the needle between his ribs, rapidly injecting his side several times in a hasty attempt to numb him against the coming pain.
Oh crap, my gown isn't going on and half the ED is watching and I know I'm supposed to scrub for this but let's be honest, I am only here to learn in a situation where only essential personnel need to be present and oh god, I almost dropped my glove. I'm going to look like a moron.
The resident whipped into his gown and gloves much more rapidly than I could hope to manage. By this time, the patient was starting to hyperventilate.
"Fuck, fuuuuuuck! I can't breathe, I can't breathe doctor, fuuuuuuuck! Help me, please, help me! I can't breathe!"
The pneumothorax was pretty straightforward on CXR. His vitals are stable, heart rate and blood pressure are in a normal enough range for someone who's been stabbed in the back. This isn't a tension pneumo, his sats are good. I wonder why he's having trouble breathing now? Agh, finally got the glove on. My hair is in my face. I need a haircut.
"I can't...doctor...please!"
Everything started moving in a rush. The resident abandoned attempts to wait for the numbing medication to kick in and snatched up the knife, quickly slicing through skin and muscle through the ribs. The patient jerked his arm but it was held firmly over his head by the large respiratory tech to the left of the bed. The jerking synced with the yells as the resident quickly inserted a pair of scissors into the wound and spread them, simultaneously breaching the parietal pleura and widening the gap. The air hissed out in an audible rush, visibly deflating the chest wall.
"Aggghhhh fuuuuck!"
Wow. That...was cool. His trachea just moved back to center instead of being squished to the side by all the compressed air. I actually saw it move. I shouldn't be so giddy about that. I can't see very well. I wish I actually knew what to do--I'd feel much more comfortable.
The resident whipped up the large, 1-inch chest tube and began to work it into the bleeding wound. The patient's shouts became screams and quickly reached a new intensity as over a foot of tubing disappeared inside him.
"OH GOD OH DOCTOR HURTS PLEASE STOP FUCK FUCK FFFFFFUUUUUCCCCCKKKKK! STOP! It hurts, it hurts! STOP!"
Oh. This is horrible. Is it supposed to hurt this much? Is he doing this right? Oh god, I wish he'd stop screaming. It makes everything so much worse.
The screaming wildly increased in decibels as a sudden rush of bright red blood swept down the tube and into the catch.
Oh bloody hell. Is this supposed to be happening? Did we just puncture his HEART or something? What do I do with my hands? Why am I hungry right now? What if I didn't eat enough for dinner, and I pass out in front of everyone? Why am I thinking about food?
The resident finished his insertion and began to stitch down the chest tube as I held it in place, the patient's yells fading off into the occasional whimpers, with his ever-constant, unimaginative "fuck" providing a tempo for the sutures.
I'll bet there's asparagus in the garden right now.
There really isn't a better way to end this story. We stitched him up and he got the chest tube out today. This dude is actually a douchebag, even when he's not being stabbed open, and he hasn't stopped swearing since he came in the doors. Still, he was my first pneumothorax, and I'm glad I was there for it. It...was awesome. Don't judge me for my thoughts, they are as close to accurate as I can remember--and really, the things your mind offers up during stressful situations are pretty funny.
Oh crap, my gown isn't going on and half the ED is watching and I know I'm supposed to scrub for this but let's be honest, I am only here to learn in a situation where only essential personnel need to be present and oh god, I almost dropped my glove. I'm going to look like a moron.
The resident whipped into his gown and gloves much more rapidly than I could hope to manage. By this time, the patient was starting to hyperventilate.
"Fuck, fuuuuuuck! I can't breathe, I can't breathe doctor, fuuuuuuuck! Help me, please, help me! I can't breathe!"
The pneumothorax was pretty straightforward on CXR. His vitals are stable, heart rate and blood pressure are in a normal enough range for someone who's been stabbed in the back. This isn't a tension pneumo, his sats are good. I wonder why he's having trouble breathing now? Agh, finally got the glove on. My hair is in my face. I need a haircut.
"I can't...doctor...please!"
Everything started moving in a rush. The resident abandoned attempts to wait for the numbing medication to kick in and snatched up the knife, quickly slicing through skin and muscle through the ribs. The patient jerked his arm but it was held firmly over his head by the large respiratory tech to the left of the bed. The jerking synced with the yells as the resident quickly inserted a pair of scissors into the wound and spread them, simultaneously breaching the parietal pleura and widening the gap. The air hissed out in an audible rush, visibly deflating the chest wall.
"Aggghhhh fuuuuck!"
Wow. That...was cool. His trachea just moved back to center instead of being squished to the side by all the compressed air. I actually saw it move. I shouldn't be so giddy about that. I can't see very well. I wish I actually knew what to do--I'd feel much more comfortable.
The resident whipped up the large, 1-inch chest tube and began to work it into the bleeding wound. The patient's shouts became screams and quickly reached a new intensity as over a foot of tubing disappeared inside him.
"OH GOD OH DOCTOR HURTS PLEASE STOP FUCK FUCK FFFFFFUUUUUCCCCCKKKKK! STOP! It hurts, it hurts! STOP!"
Oh. This is horrible. Is it supposed to hurt this much? Is he doing this right? Oh god, I wish he'd stop screaming. It makes everything so much worse.
The screaming wildly increased in decibels as a sudden rush of bright red blood swept down the tube and into the catch.
Oh bloody hell. Is this supposed to be happening? Did we just puncture his HEART or something? What do I do with my hands? Why am I hungry right now? What if I didn't eat enough for dinner, and I pass out in front of everyone? Why am I thinking about food?
The resident finished his insertion and began to stitch down the chest tube as I held it in place, the patient's yells fading off into the occasional whimpers, with his ever-constant, unimaginative "fuck" providing a tempo for the sutures.
I'll bet there's asparagus in the garden right now.
There really isn't a better way to end this story. We stitched him up and he got the chest tube out today. This dude is actually a douchebag, even when he's not being stabbed open, and he hasn't stopped swearing since he came in the doors. Still, he was my first pneumothorax, and I'm glad I was there for it. It...was awesome. Don't judge me for my thoughts, they are as close to accurate as I can remember--and really, the things your mind offers up during stressful situations are pretty funny.
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