Tension Pneumothorax or Decreased Level of Consciousness

  1. If two patients present to the emergency department at the same time, one with a tension pneumothorax and the other with decreased LOC, which one should receive attention first? Thanks.
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  2. 13 Comments

  3. by   berry
    Quote from Rick Bourdier
    If two patients present to the emergency department at the same time, one with a tension pneumothorax and the other with decreased LOC, which one should receive attention first? Thanks.

    I would pick the pneumothorax if the other is just a decreased loc, my reason Trauma assessment Airway, Breathing, Circulation, Disablity(neuro Checks, oreintation) but "decreased LOC is such a broad complaint are they unresponsives possabilty of losing ariway then i take them over the pneumo or have the just been "acting different for a few days". is this a real world scene or a textbook question
  4. by   veetach
    The patient with the pneumothorax. Always follow your ABC rule, AIRWAY comes first.
  5. by   RNin92
    Quote from veetach
    The patient with the pneumothorax. Always follow your ABC rule, AIRWAY comes first.
    I'm with veetach...
    AIRWAY-AIRWAY-AIRWAY
  6. by   trsnurse
    Quote from RNin92
    I'm with veetach...
    AIRWAY-AIRWAY-AIRWAY
    ditto AIRWAY!
  7. by   gij1
    I would definately pick pnuemothorax, although decreased LOC is alarming. Good ole ABC's. Did you get this on a test??? Let us know.
  8. by   petiteflower
    I'm with everyone else, tension pneumo
  9. by   kc ccurn
    Quote from petiteflower
    I'm with everyone else, tension pneumo

    My answer as well.
  10. by   Speculating
    Quote from Rick Bourdier
    If two patients present to the emergency department at the same time, one with a tension pneumothorax and the other with decreased LOC, which one should receive attention first? Thanks.
    As long as the pneumo was your typical young skinny white guy and it was spontanous not traumatic and he was running a good SAT I would crank the O2 up and work on the < LOC given it was caused by something not obvious. It's not likely your going to die from a spontanous pneumothorax although it is a critical situation and certainly uncomfortable there are lots of folks running around out there with only one lung at 100%. Remember with a < LOC you have a small window to work with if you have to TPA a stroke. Any type of brain injury what so ever could cause that patient to crash in a heart beat!
  11. by   RNin92
    Quote from Speculating
    As long as the pneumo was your typical young skinny white guy and it was spontanous not traumatic and he was running a good SAT I would crank the O2 up and work on the < LOC given it was caused by something not obvious. It's not likely your going to die from a spontanous pneumothorax although it is a critical situation and certainly uncomfortable there are lots of folks running around out there with only one lung at 100%. Remember with a < LOC you have a small window to work with if you have to TPA a stroke. Any type of brain injury what so ever could cause that patient to crash in a heart beat!
    You read too much into the question. The poster said TENSION pneumo not spontaneous. You have far less time to a dead pt with a tension than a CVA.

    AIRWAY first.
  12. by   Speculating
    Quote from RNin92
    You read too much into the question. The poster said TENSION pneumo not spontaneous. You have far less time to a dead pt with a tension than a CVA.

    AIRWAY first.

    Any situation that results in inducing a pneumothorax can begin the foundation of a tension pneumothorax. A tension pneumothorax is simply a complicated pneumothorax. Can a spontaneous pneumothorax be a tension pneumothorax - ABSOLUTELY! I'm simply trying to find out the root of the pneumothorax. Again that's why I asked if there was any trauma involved. I addressed the airway with cranking up the O2 and keeping a very close eye on the pts SAT. Now I'm going to address the airway in the < LOC pt which no one else has done so far. You seem believe I'm reading too much into the question I however think you're not reading into the question enough. I don't have so much as a set of VS on either pt let alone a SAT. A decreased level consciousness can be the result of low oxygen saturations. Understand that I know what I have to deal with in regard to the pneumothorax pt other than a set of VS which would be extremely helpful. I don't by any means know what I'm dealing with in regards to the pt with a decreased level of consciousness, however. You became too focused thus closed minded when you came to the conclusion that the decreased LOC was the result of a CVA. Where did you come up with that? Not that you couldn't be right. Do you think a diabetic pt with a blood sugar of 25 could have a decreased LOC? Do you imagine it's possible for a diabetic pt with a blood sugar of 1200 to have a decreased LOC? Do you suppose a pt with a serious closed head injury could have a decreased LOC? Can a low oxygen saturation cause a pt to have a decreased LOC? Do you believe a pt with a pulmonary emboli might have a decreased LOC as a result of poor oxygenation? I wonder could you trust a pt with a decreased LOC to protect there airway? You have to rule all of these things in before you can rule all of them out especially since you have nothing more to go on than a pt with a decreased LOC? By no means I'm I saying that tension pneumothorax could not be a life-threatening predicament anymore than I'm saying it is correct to look at a patient with decreased LOC and assume it's nothing more than a CVA.
  13. by   RNin92
    Quote from Speculating
    As long as the pneumo was your typical young skinny white guy and it was spontanous not traumatic and he was running a good SAT I would crank the O2 up and work on the < LOC given it was caused by something not obvious. It's not likely your going to die from a spontanous pneumothorax although it is a critical situation and certainly uncomfortable there are lots of folks running around out there with only one lung at 100%. Remember with a < LOC you have a small window to work with if you have to TPA a stroke. Any type of brain injury what so ever could cause that patient to crash in a heart beat!
    YOU stated about a small window of opportunity of TPA for a stroke. I never said anything about thinking a decreased being a stroke. I just was responding to YOUR words.

    As far as O2 sats go...they are a screening tool...not a blood gas. They are a piece of the puzzle not the answer. And you can "crank the O2 up" from now until the end of time and it will not help your AIRWAY problem in a tension pneumo.

    And all I said was...I thought you were reading too much into the question. Not challenging your choices. But in a multi-victim situation if I ONLY know that one pt is a tension pneumo and the other has a decreased LOC I will pick AIRWAY first every time. I would not FORGET the decreased LOC but he will wiat for the 2 minutes it will take for me to needle the tension and save his life.
  14. by   RN Rotten Nurse
    Quote from RNin92
    YOU stated about a small window of opportunity of TPA for a stroke. I never said anything about thinking a decreased being a stroke. I just was responding to YOUR words.

    As far as O2 sats go...they are a screening tool...not a blood gas. They are a piece of the puzzle not the answer. And you can "crank the O2 up" from now until the end of time and it will not help your AIRWAY problem in a tension pneumo.

    And all I said was...I thought you were reading too much into the question. Not challenging your choices. But in a multi-victim situation if I ONLY know that one pt is a tension pneumo and the other has a decreased LOC I will pick AIRWAY first every time. I would not FORGET the decreased LOC but he will wiat for the 2 minutes it will take for me to needle the tension and save his life.

    If this were a test question and the ONLY info I was given was 'tension pneumo' and 'decreased LOC' I would choose tension pneumo. However, in a real life situation I need just a tad bit more information. For instance, is the decreased LOC due to a man jumped off a house and landed on his head?

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