01 Mar 2012

Emergency Pneumothorax Case Study – Dahl Memorial Clinic, Alaska

This winter, Alaska declared a state of emergency on more than one occasion due to extreme winter storms. Heavy snow, freezing rain and insane winds have pummeled the state resulting in widespread avalanches and other dangers. Medics working at Dahl Memorial Clinic in Southeast Alaska put their emergency skills to the test this winter when Medivacs were unable to access the small clinic located in the remote town of Skagway, AK.

Winter in Skagway, AK. Photo Credit - Andrew Cremata

In Skagway, Medivacs are available during daylight hours only due to the high peaks surrounding the town’s small airstrip. Bad weather frequently prevents Medivacs from being able to land safely, as was the case when a young man arrived in the clinic during particularly bad weather in December.

After 10 days of increasingly shortness of breath yet no history of any injury, he finally sought medical attention after being unable to walk a few yards without extreme difficulty. Upon examination he was tachycardiac with a heart rate of 110 at rest and 91-92% at rest on room air.  All other vitals were normal but he had absent breath sounds on the right side.

Chest X-ray revealed the cause – the patient had a complete pneumothorax on the right side. Pneumothorax (or collapsed lung) is a build-up of air or gas in the pleural space that separates the lung from the chest wall. This allows the air to escape but not to return, which leads to circulatory instability and traumatic arrest if not treated immediately.

As with any medical emergency, time is of the essence. Hours, minutes or seconds can be the difference between life and death, so acting fast, nurse practitioner Carol Borg employed the Cook Emergency Pneumothorax Set to decompress the patient’s chest. Upon inspection the medic discovered an old clavicle fracture, coupled with the patient’s muscular anatomy, so the catheter had to be inserted slightly lower than normally recommended. Medics feared the FEP catheter needle might prove too short for the task, however this was not the case. The patient experienced immediate relief and air could be heard rushing loudly out of the drain valve. Within a few hours, the patient’s heart rate returned to a baseline of 70’s.

Thanks to digital radiography at the clinic, Borg was able to send X-ray images to a referring hospital for radiology over-read and advice. After consulting with the emergency department doctor and radiologist at the referral hospital, as well as a surgeon in Juneau, it was deemed unnecessary to transport the individual. Medics firmly secured the catheter in place and sent him home. He returned the next day for a follow up X-ray and subsequent catheter removal, and by all reports was well on his way to a speedy recovery.

Available at Chinookmed.com, the Cook Emergency Pneumothorax Set is a must-have for rescuers and emergency medical professionals. Breathing is a primary concern during emergency medical situations, and the Set offers a compact design for fast and efficient response designed to meet the demands of pre-hospital transport.

Cook Emergency Pneumothorax Set - Available at Chinookmed.com

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