Tension Pneumothorax or Decreased Level of Consciousness

[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.

[RN Rotten Nurse]

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?

[thanatos]

Although I see Speculating's point regarding the patient w/ the decreased LOC, the patient w/ the TENSION pneumo should be treated first. Even though the patient w/ the decreased LOC may or may not have a life threatening condition, a TENSION pneumo IS a true airway/breathing emergency. If not treated immediately, the patient will code, probably PEA. Needle his chest first and then see to the other patient.