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Tension pneumothorax in post-anesthetic care unit: case report

BACKGROUND AND OBJECTIVES: The incidence of pneumothorax after penetrating chest trauma is 100%. Tension pneumothorax, a high mortality rate condition, may be triggered, among other causes, by pulmonary injury not previously identified, and may also be associated to mechanical ventilation. This report presents a case of tension pneumothorax diagnosed in the Post-Anesthetic Care Unit (PACU). CASE REPORT: A 34-year-old black male patient, physical status ASA I E, victim of gunshot wound was submitted to explorative laparotomy and right femoral artery and vein exploration under general balanced anesthesia with rapid sequence induction. The patient kept hemodynamically stable throughout the procedure. However, in the PACU patient presented hemodynamic instability with respiratory failure, sweating, tachycardia and hypertension. Chest CT-scan revealed right hemopneumothorax, which was immediately drained. Patient was then transferred to the Intensive Care Unit, where he progressively improved to be discharged from the hospital 22 days later, without sequelae. CONCLUSIONS: Tension pneumothorax is a fatal condition which may be easily identified through clinical and radiological evaluations. It should be always suspected in the presence of chest trauma and, in this case, immediate chest drainage should be performed prior to mechanical ventilation or any surgical procedure.


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