3rd day nerdy medical student in hospital

let's share wat interesting case 2day.

24 years old malay man came in with chest pain.vry skinny.smokers,no hypertension,no diabetes.

so CXR was made. due to the stupid film the doctor can't actually saw what happen.

after a few while finally the doctor saw something .that's tension pneumothorax.

so,a needle thoracocentesis need to made to suck out the air/fluid in the cavity.

so,immediately transfer this patient from yellow zone to red zone(resus)..haha..then u can heard the bell ring 3 times again..i heard they say when the bell ring 3 times means thr's new case in red zone. ring 1 time new case in yellow zone.

so,following to red zone.then they preparing n start to perform needle thoracocentesis immediately.

this is exactly what thoracocentesis like 

after thoracocentesis the patient sent to ICU ward. after few hours..i dunno wat actually happen,i saw them doing chest tube insertion.can i know y they doing this again?

so..here;s the procedure look like..

Pneumothorax:

Definition : is a collection of air or gas in the pleural cavity that causes the lung to collapse

Types of pneumothorax:

i. primary spontaneous pneumothorax - this happen when a small air bubble on the lung ruptures. thr's no specific reason of this happening or th'r changing of pressure level (eg scuba diver or mountain climbing)

ii. secondary spontaneous pneumothorax - for those who already have lung diseases, as lung already compromised by disease and may have diminished capacity, this can be a serious complication.

iii. traumatic pneumothorax - injury to chest ( car wreck or gun/knife wound) causes the lung to collapse

iv. tension pneumothorax- pressure inside the cavity of lung is greater than the outside atp. It can force entire lung to collapse & can push the heart toward the lung,putting pressure on both.

Another case 

the patient's family say that patient haf lower abdominal part pain n back pain. he;s still working on that day. so after that he feel not feeling well n call his son to send him to hospital.

on the way to hospital he bcum unconscious.

so..i'm in red zone..

first the patient is unconscios, then starting to bradycardia..so evry ho n mo r prepare for emergency rescue, 

ABC is started~airway,breathing,CPR..

so airway start,airbag is put.on the same time they inserting adrenallin.

after that start CPR..on the same time ultrasound is made.

so..diagnosis is (triple A ) abdominal aortic aneurysm

which means abnormal dilatation abdominal aorta.

after rescue for a long time finallly patient pulse is back,n a surgeon came down n take a look for him.

after that,surgeon bringing him upstairs for surgery..

so..the surgeon ask me to block the lift..haha..that's the only thing i can do on that time..

unluckily the stupid lift will close by itself..=.=..but finally evrything goes right!!

then i can c how's their family reaction...kind of sad xia..especially the 1 hour + rescuing the patient n the patient still in brady cardia sumore after tat pulseless...

lucky evrythings goes well..

after few hours..the patient is back to ICU ward n when taking blood from him,he still can say it's pain(although his weak)..==

Symptoms :

i. abdominal pain or back pain( may be radiate to buttocks,groin or legs)

ii. clammy skin

iii. nausea/vomiting

iv. shock

ix. rapid heart rate

Test:

CT scan and ultrasound in the abdominal cavity.

Causes:

i. tobacco smoking

ii. genetics

iii. atherosclerosis

iv. other causes like infection ,trauma,arteritis,cystic medical  necrosis.

iiv. high BP

iiiv high cholesterol

ix. obesity

Treatment:

2 kind of surgery:

i.  traditional (open) repair, a large cut is made on ur abdomen.then the abnormal vessel is replaced by a substance such as Dacron.

ii. Endovascular stent grafting