Spontaneous Pneumo in Teen

Published

Specializes in Maternal - Child Health.

I've seen this plenty in my NICU babies, but know nothing about adolescents, so thought I'd bounce this off you experts.

My friend's son (a healthy, active 16 year old), woke up one morning with cyanosis of the hands and c/o chest pain. His parents took him to the ER where they were told that he had a small pneumothorax. The ER doc explained that small holes in the alveoli can be caused by rapid growth, and are not uncommon during growth spurts, especially in lanky boys, which he is. (I didn't know that.)

The doc explained that he needed to needle aspirate the boy's chest (OK I get that). The kid freaked out when the needle aspiration was attempted without local or sedation. (Why no local or sedation?) The doc then told the parents that they would have been able to take their son home post-procedure if he hadn't been so dramatic, but because of the sedation which the doc thought unnecessary, he was kept overnight.

Are needle aspirations routinely done inthis manner? It sounds barbaric to me. I certainly would have insisted on a local and sedation for such a procedure.

Up Vote Up Vote ×
Specializes in pediatric ER.

I've seen chest tubes placed, but never needle aspirations... It's ALWAYS done under sedation and the kiddos are always admitted for observation. Especially if he had some cyanosis related to the pneumo.

And yes, this is pretty common in lanky teenage boys. See one a week, usually, in our pediatric ER.

-Analee

Up Vote Up Vote ×

yes they are very common, especially on tall boys

Up Vote Up Vote ×
Specializes in Nursing Ed, Ob/GYN, AD, LTC, Rehab.

What we learned in class is that they really can only provide a topical agent and that they are extremly painful to have done. Wonder if this is true in the real world though....

Up Vote Up Vote ×
Specializes in SICU/MICU and soon...CVRU.

Sedation or not I am shocked they wouldn't keep him for observation at least one night anyway. A procedure like that sounds painful, I wonder if the docs would require sedation in the event they need a needle aspiration?

Up Vote Up Vote ×
Specializes in Med/Surg, Ortho.

I can understand the no sedation. Sedation would depress the respiration and probly keep the procedure from being effective. They needed him at full wakefullness to have him deep breath and move (or not move) the way they needed him to. At 16 he really should have been able to comply with instructions without sedation. Local anestetic i would think would have been in order though. Hope the kid is doin ok.

Up Vote Up Vote ×

Happened to my long and lanky son about 4 years ago - after he had symptoms a second time, they did some testing for Marfans. It was negative. I was told then that it wasn't all that unusual among the tall and skinny.

Up Vote Up Vote ×
Specializes in NICU/Neonatal transport.

It doesn't surprise me - similar to amnios. I was given a choice between a local or no local. I went without. I'd still be getting a needle and the local wouldn't remove all the pain, just the pain of the 2nd needle piercing the skin.

Sedation can be tricky and it was fairly common at my peds ER to see this as well. Quick needle aspiration then they can go home, with instructions to return if it happens again.

Up Vote Up Vote ×
Specializes in Nursing Professional Development.

My younger brother (now 41 years old) had 4 or 5 of them back in his late teens and early 20's. Fortunately, none of them was serious and he was never actually treated. He would just "take it easy" until he felt better. He was also advised not to lift weights or do similar activities that involved that kind of straining. (Though, keep in mind that was 20 years ago and that may not have been necessary.) After the first one, he knew immediately when one would occur.

Up Vote Up Vote ×
Specializes in ICU-Stepdown.

As was said above, yes this is not an uncommon thing in tall, lanky adolescents. As for the anesthesia, its just one needlestick -so commonly they DON'T anesthetize them -but this is also done on a case-by-case basis. If this kid is easily excited, then it would have been prudent to give him something to relax him -depending on the degree of distress he was experiencing. Other than that, its a pretty simple and straight-forward procedure -and I agree, I'd have liked to see him kept overnight REGARDLESS of how he 'acted'. Its the only way to be sure :)

Up Vote Up Vote ×
Specializes in Med/Surg, ED, ortho, urology.

I witnessed one on placement in the ED. He was given morphine and midazolam.

He was awake throughout the aspiration, but was relaxed enough to handle it. No offence, but there is no way you would be coming at me with that needle without some sort of analgesia.

His 02 dropped a little but he was given oxygen and told to take some deep breaths, other than that it was fine.

Up Vote Up Vote ×
Specializes in Medical Telemetry, LTC,AlF, Skilled care.

I was lucky enough to see this when I did my rotation through the ED very young man around 17 or 18 spont. pneumo and the nurses explained that since he was tall and gangly he would probably suffer from a couple more. He came in with an O2 of 98 % on 2 L NC which was pretty impressive then again I'm used to little elderly people who drop in the 80's whenever they move lol he had a CT put in they numbed it with lidocaine and afterwards he recieved a generous dose of morphine.

Up Vote Up Vote ×
+ Join the Discussion