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you're managing a new admission who is relatively undifferentiated (presenting with hypotension, hypoxemia, and altered mental status). the radiology tech wheels out of the room and shows you this film. what is your next move? (#1/4)
c'mon, the clock is ticking! what are you going to do? (#2/4)
this is actually a skin fold, not a pneumothorax. there are several hints of this on the chest X-ray, but the safest (most idiot-proof) way to sort it out is lung ultrasonography. lung slide on POCUS at several locations on the left chest confidently & immediately excluded PTX
key points:
STAT calls from radiology about "pneumothorax" often turn out to be skin folds
unless the PTX is unequivocal & the patient is crashing (e.g., definite tension PTX), *always* do POCUS before placing a chest tube
for PTX diagnosis, POCUS eats x-ray for lunch
STAT calls from radiology about "pneumothorax" often turn out to be skin foldsunless the PTX is unequivocal & the patient is crashing (e.g., definite tension PTX), *always* do POCUS before placing a chest tubefor PTX diagnosis, POCUS eats x-ray for lunch
