The Aftermath of Cocaine-Induced Pneumothorax

By Joshua B. Hourizadeh, DO, & Joseph VM Kelly, MD, MBA   A 38-year-old African American man presented to the emergency department with severe left-sided inspiratory chest pain with no radiation for two days and increasing shortness of breath. The patient said he had recently broken up with his girlfriend, which lead him to smoke crack cocaine for three consecutive days.   The patient had no past medical or surgical history, but he had a past social history of illicit drug abuse, nicotine use, and social alcohol use. His heart rate was 96 bpm, blood pressure was 112/80 mm Hg, oxygen saturation was 86% on room air, his respiratory rate was 24 bpm, and his temperature was 98.7°F. Physical examination was unimpressive with the exception of diminished breath sounds on the left side. Chest radiograph (Figure 1) displayed a left-sided pneumothorax with a mediastinal shift indicating the beginning of a possible tension pneumothorax. A tube thoracostomy was placed, and water seal pressure was applied without any suction apparatus. The patient felt immediate relief once the thoracostomy tube was in place, and his oxygen saturation improved to 95%. The patient was placed on oxygen therapy at 2 l/min.   Figure 1.   Three hours after tube thoracostomy placement, the patient complained of increasing dyspnea, and said he had pain at the thoracostomy site. Auscultation of the chest revealed inspiratory crackles on the left side. Oxygen saturation fell to 83%, and arterial...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research