A previously fit 45 year old man was noted to be in respiratory distress 24 hours following maxillofacial surgery.
Clinical examination revealed the following:
• Respiratory rate of 22/min
• Decreased air entry left side
• Crackles left base
• HR-104/min, regular. JVP not raised. Apical impulse 5th left intercostal space anterior axillary line.
• ECG – normal
• Chest X-Ray – complete whiteout on the left side.
(a) What is the likely cause of his respiratory distress?
From the examination findings, it seems his patient in respiratory distress has some sort of left-sided lung pathology and a completely normal cardiovascular examination. The JVP is not raised , so probably this is not a heart-related thing. The usual apex beat is in the mid-clavicular line, so the apex beat is actually displaced - it has moved in the direction of the quiet lung. If the lung was quiet because of some sort of space-occupying process, the mediastinum would have shifted away from the quiet lung (eg. if there was massive haemothorax or pleural effusion).
The maxillofacial surgery is a clue. They either inhaled some blood post-operatively, have a sputum plug, have aspirated, or are suffering post-operative atelectasis.