Question

What is the most likely diagnosis for a patient on a ventilator with sudden onset tachypnea, pleuritic chest pain, BP 80/50, JVD, hyperresonance to percussion of the right lung, and absent breath sounds in the right lung?

1) Pneumothorax
2) Pulmonary embolism
3) Acute respiratory distress syndrome (ARDS)
4) Pulmonary edema

Answer 1

The patient's symptoms indicate a likely diagnosis of Pneumothorax, given the hyperresonance on percussion, absent breath sounds on one side, and signs of tension with hypotension and JVD.

Step-by-step explanation:

The most likely diagnosis for a patient on a ventilator with sudden onset tachypnea, pleuritic chest pain, BP 80/50, JVD, hyperresonance to percussion of the right lung, and absent breath sounds in the right lung is (1) Pneumothorax. This condition is characterized by a collapsed lung, often indicated by hyperresonance due to the presence of air in the pleural space and absent breath sounds over the affected area. In contrast, Pulmonary edema would more commonly present with diffuse crackles on auscultation rather than absent breath sounds, and Pulmonary embolism would typically not cause hyperresonance to percussion. Acute respiratory distress syndrome (ARDS) usually presents with bilateral infiltrates on imaging, rather than unilateral hyperresonance. Additionally, the presence of JVD (jugular venous distention) along with hypotension (BP 80/50) suggests tension pneumothorax, which is a life-threatening emergency where air accumulates under pressure, collapsing the lung and pushing on the heart and great vessels, causing a drop in blood pressure and potentially obstructive shock.