Question

An infant receiving mechanical ventilation acutely develops cyanosis and a sudden drop in blood pressure. A pneumothorax is suspected, but the patient's chest cannot be auscultated due to the noise in the room. The RT should:

a) Perform immediate chest compressions.

b) Continue mechanical ventilation and monitor.

c) Administer a bronchodilator.

d) Insert a chest tube.

Answer 1

In the case of an infant with suspected pneumothorax and acute cyanosis on mechanical ventilation, the appropriate action is to insert a chest tube to relieve pressure and allow the lung to re-expand. Chest compressions and bronchodilators are not the correct interventions in this scenario.

Step-by-step explanation:

If an infant on mechanical ventilation acutely develops cyanosis and a sudden drop in blood pressure, with pneumothorax being suspected, the respiratory therapist (RT) should immediately intervene. Auscultation of the chest may be impossible in noisy environments; therefore, visual assessment, review of ventilator settings and alarms, and other clinical signs should be used to evaluate the situation. If a pneumothorax is strongly suspected and there is a risk of tension pneumothorax, the RT may need to perform an emergency procedure to relieve the pressure in the chest cavity. The appropriate action would be to insert a chest tube to remove the air from the pleural space and allow the lung to re-expand. Emergency chest compressions would only be indicated if the infant had a cardiac arrest. Administering a bronchodilator without addressing the suspected pneumothorax would not resolve the acute issue, and merely continuing to monitor the patient on mechanical ventilation without intervention could lead to a worsening of the condition.