One Kiss in Tokyo... Read Free Page B

pneuomothorax, each requiring different management.
    In their absence, someone had cleared the resus room. Both bays were empty again. Avery grabbed the pink stethoscope that was hanging around Katsuko’s neck. ‘Hey!’ she shouted.
    â€˜Needs must. Haven’t been able to find mine yet.’
    As the trolley eased to a halt he listened carefully to both sides of the man’s chest. He waved his hand. ‘Sit him forward so I can check his back.’ Two nursing assistants responded instantly, helping to sit the man forward. The back was clear. No sign of any wounds. The patient was eased back. The shift in the trachea was evident. There was no need for anything else. A pneumothorax was air in the chest cavity. This had probably resulted from a fractured rib puncturing his lung and releasing air into the pleural space. A pneumothorax wasn’t usually life-threatening unless it progressed to a tension pneumothorax, causing compression of the vena cava, reducing cardiac blood flow to the heart and decreasing cardiac output—and that was exactly what had happened here.
    A tension pneumothorax could be life-threatening and needed prompt action. The military had collected vast amounts of data regarding tension pneumothorax and subsequent treatment. In a combat setting, tension pneumothorax was the second leading cause of death, and was often preventable. Today Avery was going to make sure it was preventable.
    â€˜Tension pneumothorax.’
    Two words were all it took. Packs opened around him. Surgical gloves appeared. He pulled them on and swabbed the skin. Katsuko was speaking into the man’s ear in a low voice. She waved Avery on with a nod of her head.
    â€˜Let’s get some oxygen on the patient.’
    The staff responded instantly.
    â€˜Do we have a name?’
    His body was already starved of oxygen. They had to supplement as much as possible.
    One of the physician’s assistants put his hand in the man’s pocket and pulled out a wallet. ‘Akio Yamada.’ He frowned as he calculated in his head. ‘I make him forty-four.’
    Avery leaned over the man. His eyes were tightly closed and he was wincing, obviously in pain. He put his hand gently on his shoulder. ‘Akio, I’m a doctor. I’m going to do something that will help your breathing. It might be a little uncomfortable.’
    This wasn’t a pleasant procedure but the effect would be almost instant relief. Air was trapped and had caused the man’s lung to collapse. As soon as the pressure was relieved and the lung reinflated he’d be able to breathe more easily again. Katsuko gave a nod that she’d finished translating.
    There were specially manufactured needles designed just for a tension pneumothorax. Avery held out his hand. ‘Fourteen-gauge needle and catheter.’ He’d done this on numerous occasions in the past. It only took a few seconds to feel with his fingers for the second intercostal space, at the midclavicular line. It was vital that the needle be inserted at a ninety-degree angle to the chest wall so it would be positioned directly into the pleural space. Any mistake could result in a chance of hitting other structures—even the heart. But Avery was experienced.
    The room was silent during the procedure. In a few seconds there was an audible release as the trapped air rushed out and the tension was released from his chest. Avery removed the needle and disposed of it, leaving the catheter in place. He secured it with some tape as he watched the man’s chest. Sometimes the lung inflated again immediately, sometimes it took a little time. The patient would need to be monitored.
    He pulled off his gloves. ‘Can we keep an eye on his sats for the next few hours and get a portable chest X-ray?’ The man’s eyes flickered open.
    Avery put a hand on his shoulder. It didn’t matter that the patient couldn’t understand him. ‘You should