She is in respiratory distress with accessory muscle use. Her heart rate is 130, her blood pressure is 90/30, her respiratory rate is 35 and her oxygen saturations are 88% on a 100% non rebreather mask.
You listen to her chest, and you hear decreased breath sounds on the left, and absent breath sounds on the right.
You perform a quick bedside ultrasound of both lungs, starting on the left, that reveals the following images:
This is an example of a tension pneumothorax, which requires urgent treatment with needle decompression and chest tube insertion. Bedside ultrasound is a quick diagnostic test to aid in the diagnosis.
The first images are of a normal lung, with pleural sliding seen on 2D images corresponding with respirations. In M-Mode, the seashore sign can be seen, with the appearance of waves in the top half of the image while the bottom half appears like sand.
In a pneumothorax (00:38), however, there is no longer a pleural slide, and there is the more homogenous "barcode sign" in M-Mode.
Although these ultrasound signs can indicate the presence of a pneumothorax, the diagnosis of a tension pneumothorax is based on clinical signs as described above, particularly the respiratory distress and hemodynamic instability.
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