Saturday, January 31, 2009
Andrew Bynum Cheats
You don't normally expect to end up with a level 1 trauma injury at an NBA basketball game. Maybe NHL hockey, but not the NBA. Gerald Wallace got crushed by Lakers center Andrew Bynum the other night (see above), resulting in multiple rib fractures and a "collapsed lung" (in the verbiage of national sports reports.) I hate that phrase. Yes, the lung does sort of "collapse" but it sounds so unheroic and weak-willed, as if the lung simply gave up its ghost from sheer exhaustion. Consider the actual medical term: Pneumothorax. Now isn't that a lot cooler? Sounds like the name of the main protagonist in some sci-fi action film. Pneumothorax. Much better.
A pneumothorax results when the thin membranes lining the alveoli (air sacs of the lung) are ruptured, thereby allowing an abnormal communication between the air we inspire and the thoracic cavity. The cavity fills up with air and compresses the thin, fragile lung tissue in such a fashion (i.e. collapsing the lung) that oxygen exchange is compromised. Furthermore, blood return to the heart is impeded because of the increased intra-thoracic pressure. On exam, a patient suffering from a tension pneumothorax will present with hypotension, hypoxemia, absent breath sounds, hyperresonance to percussion, and distended neck veins. People can die from this without immediate intervention.
The treatment involves decompressing that thoracic cavity. If the patient is in extremis, the best and fastest thing is to place a large bore angiocatheter between the 2nd and 3rd ribs into the pleural cavity. Defintive therapy requires placement of a chest tube into the thoracic cavity. This allows for continuous evacuation of the air that wants to accumulate, lets the lung re-expand, and allows for the thin pleural membranes to heal (usually takes 24-72 hours or so). Gerald Wallace's lung was punctured by the sharp fragments of bone from his rib fractures. Apparently, he's now home and doing well. But don't expect him back on the court for 2-3 months....