Collapsing Callum — Tension Pneumothorax & Chest Tubes: Tracheal Deviation and the Water Seal
He was stabbed in the chest, now he cannot catch his breath — and his windpipe is sliding away from the wound
Callum arrives after a stab wound to the right chest. He is gasping, his right chest is silent, and his trachea is drifting left.
Callum has air trapped in his pleural space that cannot escape. Every breath pumps more air in, the pressure rises, and it shoves his trachea and mediastinum AWAY from the injured side. The classic cluster: sudden sharp chest pain, absent breath sounds on the injured side, severe dyspnea, tachycardia, falling oxygen saturation, distended neck veins and LATE tracheal deviation away from the injury. A tension pneumothorax is a needle-decompression emergency. A chest tube drains the air into a water-seal system: gentle bubbling in the suction chamber is expected, continuous bubbling in the water-seal chamber means an air leak, and the tube is never clamped routinely.
Read Collapsing Callum's full story →The story arc
The setup
Callum is stabbed in the right chest at work. Within an hour he is anxious, tachycardic and cannot finish a sentence.
The turn
His right chest goes silent, his oxygen saturation falls to 84%, his neck veins distend, and his trachea shifts to the left.
The crisis
Callum's blood pressure is dropping. Waiting for imaging would cost him his circulation — this is a clinical diagnosis.
The save
A chest tube is placed to water seal and suction. The nurse notes gentle bubbling in the suction chamber, tidaling in the water seal, and keeps the system below his chest with no dependent loops.
NCLEX study section — Tension Pneumothorax & Chest Tubes: Tracheal Deviation and the Water Seal
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Respiratory
Take this chapter into practice questions on the same topic.