COPDE with Pneumothorax

This case was written by Dr. Lindsay McMurray. She is an emergency physician at The Ottawa Hospital and Lecturer at the University of Ottawa. She has a special interest in simulation and resuscitation, and is a Simulation Educator for the University of Ottawa FRCP and CCFP emergency medicine residency programs.


Critically ill patients often require aggressive treatment. But all critical care procedures and medications carry inherent side effects and risks. Emergency physicians who provide critical care must be able to recognize the acute complications of critical interventions and know how to correct them.


An elderly patient with COPD on home oxygen arrives at the ED with EMS with severe shortness of breath. He is hypoxic and agitated. He is placed in a resuscitation room and requires immediate medical attention.


A 68-year old man with COPD requiring home oxygen presents with respiratory failure. He is hypoxic, hypercarbic and agitated and will require intubation. Dissociative-dosed ketamine and BiPAP can facilitate pre-oxygenation. After a successful intubation, the high pressure alarms on the ventilator will go off. The team leader must troubleshoot the high ventilation pressures until they find and treat a tension pneumothorax.


EKG from: Life in the Fast Lane
Case courtesy of Dr Jeremy Jones, From the case rID: 6410

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