The current patient may be experiencing a range of traumatic injuries after his accident, the injuries that the paramedic will focus on are those that are most life threatening. These injuries include: a possible tension pneumothroax or a haemothorax, hypovolemic shock, a mild or stable pelvic fracture and tibia fibula fracture.
A pneumothorax is defined as “the presence of air or gas in the plural cavity which can impair oxygenation and/or ventilation” (Daley, 2014). The development of a pneumothorax to a tension pneumothorax can be caused from positive pressure ventilation.
A tension pneumothorax can be caused by a blunt or penetrating trauma, in the case study provided it would be a blunt trauma. The trauma to the chest area causes damage to the plural cavity; either the visceral (lines either lung) or parietal plura (lines the thoracic wall), or can be caused by trauma to the traceobronchial tree (Daley, 2014). The trauma to the chest area causes the formation of a one-way-valve, this allows for the air to flow into the plural space on inhalation, but on exhalation cannot be expelled (Curtis, Ramsden, & Lord, 2011). As the trapped air in the lungs build up within the affected side it can cause serious complications. In the case study it is the left lung that is in distress, and as the pressure increases within the left lung it can cause an impaired venus return to the right atrium (Daley, 2014). The increased pressure can eventually affect the right lung as the pressure builds in the left side and causes mediastinal shift which increases pressure on the right lung, which decreases the patients ability to breath, and diffuse the bodies tissues appropriately. The increase in pressure on the left side where the original trauma was can cause the lung to collapse (Daley, 2014). A collapsed lung can lead to the patient suffering from hypoxia because of the insufficient gas exchange, this and the decreased venus return will have an negative affect on the cardiac output of the patient (Daley, 2014). The relevant signs and symptoms that indicate tension pneumothorax within the current patient include anxiety, dyspnoea, tachycardia (faster than 135bpm tension is likely), hypotension, diminished breath sounds on the left side, hypovolemic shock, and unequal expansion of chest (Daley, 2014).
A haemothorax is mainly caused by trauma to the chest area, in the current patient blunt chest trauma has caused the patients injuries. The blunt trauma to the chest causes a disturbance of some of the structures of the chest, which can lead to laceration of internal vessels (Mancini, 2014). Blood accumulates within the patient’s plural space due to the laceration of surrounding vessels, creating an increased pressure, and can lead to respiratory and circulatory distress within the patient. The symptoms in the current patient has presented with symptoms that indicate a haemothorax include; tachypnoea, dyspnoea, decreased breath sounds, a dullness on percussion,...