Respiratory Distress Mr. B has been transferred to your floor to wait and see wh

Question

Respiratory Distress Mr. B has been transferred to your floor to wait and see whether the chest tube allows his lungs to completely re-expand. But when he arrives, he is in severe respiratory distress. He says "I felt before I came into the ERJ is this tube doing anything?" You tell the Clinical Nurse Specialist (CNS). As the two of you move him into the bed, you notice that his chest tube bottle is lying on its side on the gurney, with air going into it. When you point this out to the CNS, she immediately grabs the bottle and sets it upright on the floor. You see air start bubbling through the fluid right away. "That was the problem" she says. "They lost the water seal, and air was going into his chest from the bottle. You would not believe how many that happens on transport." When you examine Mr. B, you have trouble defecting his lung sounds on the left. Even stronger, his special heart sound is in the wrong place - it is over toward the right side of his chest. His respiration rate and heart rate are both increased, and he is struggling to breathe. "Let's give him a little oxygen. He'll be a lot better in a half hour, " says the CNS. "Check back on him." Why would accumulation of air in his pleural space cause his heart sounds to be in the wrong place? Choose the best explanation.

Explanation / Answer

Chest tube insertions are used to treat conditions that causes the lungs to collapse because air in the pleural space hampers, the ability of a patient to breathe. Persistent or unexplained leaks in the tube is one of the complication associated with chest tube insertion.

The lungs are located in the thorax and lies on either side of the heart. It is enclosed in an air tight pleural cavity, with a small pleural space separating the lung from the chest wall. This cavity is lined by the pleural lining, which also produces a little pleural fluid to reduce friction between the chest wall and lungs during breathing. Accumulation of air in the pleural sac cause one's heart sounds to be in the wrong place because the left side of Mr. B's chest is filling up with air, the organs in his chest are being pushed over to the right.

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