- What is the diagnosis?
There are several possible causes for Mr Tanaka’s cardiac arrest.
Work through the 4H’s and 4T’s to identify any reversible causes of Mr Tanaka’s cardiac arrest. In asthma the relevant reversible causes could be:
- Hypoxia – due to respiratory failure
- Hypovolaemia - due to infection
- Hypo-/hyperkalaemia/metabolic due to illness, drugs
- Toxins – side effects of drugs
- Tension pneumothorax – this is the correct diagnosis for Mr Tanaka
The signs for tension pneumothorax include:
- Unilateral expansion of the chest wall, shifting of the trachea
- Subcutaneous emphysema
Early needle decompression (thoracocentesis) followed by chest drain insertion is needed. Be aware that needle decompression may fail due to inadequate needle length. In the ventilated patient, thoracostomy (a surgical hole in the chest wall and pleura) may be quicker to do and more effective for decompressing.
Select Next to continue.References
See chapter 12 of the ALS manual for further reading about Special Circumstances.
Essentials: Severity of Acute Asthma Exacerbations
The severity of acute asthma is summarised in this table. (From British Thoracic Society/ Scottish Intercollegiate Guidelines Network Guideline on the Management of Asthma – www.brit-thoracic.org.uk/
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