PDF(Pubmed)
Abstract：
Chest tube insertion is a common and relatively safe procedure in an emergency setting. However, a potentially fatal complication, vasovagal reflex, may be under-recognized due to its generally mild severity. We present a case of pulseless electrical activity (PEA) requiring chest compression due to vasovagal reflex during chest tube insertion for spontaneous pneumothorax. A 23-year-old male who had a history of spontaneous pneumothorax presented with left chest pain to our emergency department. Based on point-of-care ultrasonography and chest radiography, we made a diagnosis of recurrent pneumothorax. Although he had stable vital signs and received adequate pain control, during chest tube insertion, he developed severe sinus bradycardia with a six-second pause, leading to PEA requiring chest compressions. After a few compressions, his heart rate increased and he regained consciousness. He underwent video-assisted thoracoscopic surgery for pneumothorax and was discharged without complications. Vasovagal reflex during chest tube insertion in young patients with spontaneous pneumothorax may cause severe bradycardia and cardiac arrest. Physicians should be aware of this rare but potentially fatal complication and be prepared with appropriate measures, such as pre-administration of atropine, before chest tube insertion.
摘要：
在紧急情况下，插入胸管是一种常见且相对安全的程序。然而,潜在的致命并发症,血管迷走反射,由于其一般轻微的严重程度，可能被低估。我们介绍了一例无脉电活动（PEA），由于自发性气胸在插入胸管期间因血管迷走神经反射而需要胸部按压。一名23岁的男性，有自发性气胸病史，向我们的急诊科提出左胸痛。基于现场护理超声和胸部X线摄影，我们诊断为复发性气胸。尽管他的生命体征稳定，疼痛得到了充分控制，在胸管插入期间，他出现了严重的窦性心动过缓，停顿了六秒，导致PEA需要胸部按压。几次按压后，他的心率加快，恢复了意识。他接受了电视胸腔镜手术治疗气胸，出院，无并发症。自发性气胸年轻患者在胸管插入过程中的血管迷走反射可能会导致严重的心动过缓和心脏骤停。医生应该意识到这种罕见但可能致命的并发症，并准备采取适当的措施。例如阿托品的预先给药，胸管插入前。
