The patient is brought to the emergency department following a gunshot wound to the right chest. The patient is noted to have tracheal deviation to the left side with absent breath sounds on the right. Review of the chest radiograph indicates a large amount of free air in the superior chest as well as fluid in the inferior chest. Which procedure is performed first?

Anterior thoracotomy to evacuate the pneumothorax. The patient has a tension pneumothorax and a hemothorax. Because the pneumothorax is causing tracheal deviation, it is compromising cardiac function through compression. Evacuation of the pneumothorax with an anterior thoracotomy is performed first. Then, a posterior thoracotomy can be performed to facilitate drainage of the hemothorax. Due to gravity, an anterior thoracotomy is not used to evacuate a hemothorax and a posterior thoracotomy is not used to evacuate a pneumothorax.

The patient is brought to the emergency department following a gu...

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Physiological Adaptation
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Category: Physiological Adaptation
Difficulty: 8

Topics: Cardiovascular Respiratory Delegation, Prioritization and Leadership

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