Question

An 8-year-old child was struck by a car. He arrives in the ED alert, anxious, and in respiratory distress. His cervical spine is immobilized, and he is receiving 10-L/min flow of 100% oxygen by nonrebreathing face mask. His RR is 60 bpm, HR 150 bpm, SBP 70 mmHg, and SpO2 84%. Breath sounds are absent over the R chest but present over the L chest, and the trachea is deviated to the L. He has weak central pulses and absent distal pulses. What intervention should be perfomed next?

Answer 1

The 8-year-old child showing signs of tension pneumothorax requires immediate emergency decompression of the pneumothorax through needle thoracostomy or chest tube insertion to alleviate pressure and stabilize the child.

Step-by-step explanation:

The scenario presented describes a child with signs of severe respiratory distress, likely due to a tension pneumothorax, indicated by absent breath sounds over the right chest, tracheal deviation to the left, high respiratory rate (RR), tachycardia (heart rate, HR), hypotension (systolic blood pressure, SBP), and low oxygen saturation (SpO2). The deviated trachea, which indicates shifting of the mediastinal structures, is a particularly serious sign that requires immediate intervention. The next intervention should be the emergency decompression of the pneumothorax. This is typically performed by needle thoracostomy or chest tube insertion to allow the trapped air to escape, followed by securing an occlusive dressing and preparing for immediate surgical intervention if needed. This procedure can alleviate the pressure on the lung and mediastinal structures, potentially saving the child's life.