A 23yo man has been stabbed in the back and has SOB. The trachea is not deviated, he has
engorged neck veins and absent breath sounds on the right. What is the most appropriate dx? a. Tension pneumothorax
b. Cardiac tamponade
c. Simple pneumothorax
e. Pleural effusion
Q. 1. What is the key?
Q. 2. What are the point in favour of your answer?
Ans. 1. The key is A. Tension pneumothorax.
Ans. 2. Points in favour: i) Stab wound in the back ii) SOB iii) Engorged neck vein iv) Absent breath sound.
These features are common for both hemothorax and tension pneumothorax and tracheal deviation is common to both! But chance of tension pneumothorax is more in stab wond and no tracheal deviation is controversial. This is probability of bad recall!!