On auscultation, the patient was found to have no respiratory murmur and hyperresonant percussion on the right side, with the left lung completely normal. Using a chest x-ray, we saw a pneumothorax on the right with a subtotal lung collapse (Figure 1). Figure see more 1 The first chest x-ray. We find a pneumothorax on the right with a subtotal lung collapse. Under insufflation of 4 l O1/2/min, the arterial

blood gas showed signs of a respiratory partial insufficiency: the pO2 was 50 mmHg and pCO2 43 mmHg. Apart from a leucocytosis of 17, 9 mg/dl, the blood examination was without pathological findings. Based on the diagnosis of a posttraumatic pneumothorax we immediately performed the insertion of a chest tube in Buelau technique located in the 5th ICR, proximal axillary line under local anaesthesia, and connected it to a 3-chamber chest drain system with suction of 20 cm water column. The pre-treatment time took approximately twenty minutes. The pulmonary condition of the patient ameliorated (pO2 72 mmHg, pCO2 38 mmHg), both lungs were ventilated and SpO1/2 increased ten AZD3965 minutes after the intervention up to 99%. Because of a moderate analgesic and sedative medication, we kept the patient for further monitoring in our anaesthetic recovery room. Here the patient reported

only light pain at the entrance BVD-523 research buy of the drainage, without having any dyspnoea. Two hours later, the patient’s condition rapidly worsened. He was pale, sweating, tachypnoic and complained of increasing chest pain with dyspnoea. Phosphoprotein phosphatase In spite of 10 l/min O1/2, the SpO1/2 was only 82% with a heart rate of 122/min and a decreasing blood pressure. Checking the arterial blood gas, the pO2 was 61 mmHg and pCO2 58 mmHg, indicating now a global respiratory failure Immediately a chest x-ray was taken (Figure 2). Although the lung seemed expanded correctly,

there was a suspect shadow along the chest wall, where the tube was entering. Because of the suspicion of a haematoma of the thoracic wall, we checked the haemoglobin, which was stable at 14 g/dl. Furthermore there was no blood in the tube. Meanwhile the patient’s condition got worse progressively, so that we decided to initiate an intubation to be able to improve the oxygenation using mechanical respiration. At the inspection of the pharynx, an immense amount of suppuration was blocking the upper respiratory tract. Finally 350 ml of putrid mucos were sucked off, whereupon a tracheal intubation could be performed. Now the mechanical ventilation of the patient was easy to handle and in the following twenty minutes another 300 ml mucos were removed. Figure 2 The second chest x-ray with the thoracic drain. The lung is correctly expanded. There is a suspect shadow along the lateral right chest wall. After that, we did a CT scan of the thorax, which surprisingly showed a marked ipsilateral lung edema, designated as a reexpansion pulmonary edema.