#ive been drawing pressure characters for several days straight

[lmadsadness]

in the end, Shockwave took him out in a dating type of way

[arolesbianism]

Sorry for failing to post more than once every 3 am anyways more stalien icons 👍

[scriptmedic]

TENSION PNEUMOTHORAX MULTI-ASK

Hey there lovelies! Thanks so much for your asks!

First off, basics: check the ( thoracic trauma ) tag and the ( pneumothorax ) tag. This is ground we've covered before!

There's also a chapter in Blood on the Page: a Writer's Compendium of Injuries (amazon link; yes, I am the author) on pneumothoraces. I believe it's in section 2.2: Penetrating Trauma > Chest.

I genuinely thought this chapter had already posted, but it hasn't.

So have a free chapter on me! (Below the cut)

Tension Pneumothorax

Lethality Index

5 / 5

What Is It?

Tension pneumothorax is a life-threatening injury that occurs when air gets into the chest but is outside the lungs. The buildup of air begins to put pressure on the lung, the heart, and the great veins. The condition is rapidly lethal.

Breathing is a pressure system. To inhale, the body pushes the diaphragm down and expands the ribs, which creates negative pressure in the lungs; that negative pressure draws air into the lungs from the outside world. To exhale, the diaphragm comes up and the chest relaxes — it gets smaller — pushing the air out. Easy peasy.

Tension pneumothorax changes this closed system to an open one, where air leaks from the lung into the sac around the lungs (the pleura) and gets trapped there. Positive pressure then builds up in the pleura, compressing the lung.

The fact that there's air in the lung is known as simple pneumothorax. (Pneumomeans air, and thorax means chest.)

What makes a tension pneumothorax such a big problem is that the air pocket in the pleura becomes large enough that it collapses the lung.

In addition to collapsing the lung, having that much pressure on one side of the chest is a big problem. It actually causes the organs of the chest to shift, to skooch over to the other side. In that shifting, the heart and other lung wind up pinching off blood flow through the heart, reducing blood flow everywhere.

Clinical Signs

· Severe, worsening shortness of breath, with rapid breaths.

· Diaphoresis (sweating).

· Elevated heart rate.

· Narrow pulse pressure (the “distance” between the systolic (top number) pressure and the diastolic (bottom number) pressure; e.g. 90/80 instead of 120/80).

· Engorged veins in the neck (jugular venous distention, JVD).

· Cyanosis (bluing of the skin of the lips and nail beds). (Late)

· Cold, clammy skin. (Late)

· Tracheal shift — the trachea is no longer midline in the neck, and instead is pushed away from the affected lung. (Late)

· Loss of consciousness. (Late)

· Death. (Late)

Symptoms

· Pain at the injury site and possible pain in the rest of the chest.

· Trouble breathing and panic.

· Feeling of impending doom.

· Dizziness, disorientation.

How Does It Happen?

Tension pneumothorax develops when a character suffers penetrating trauma to the chest that allows air to move between the outside and inside of the chest. This can be the result of a stabbing, shooting, impalement, or other penetrating trauma. It's especially common when the lung itself has been lacerated.

Immediate Treatment

Keep the character upright.

Provide oxygen, if available.

If the character is in respiratory failure — if they're dying — someone might give them mouth-to-mouth resuscitation or use a bag-valve-mask (BVM) to ventilate them. This actually makes the pneumothorax worse, but it may be beneficial in the short term because of increased gas exchange.

Needle Decompression

Needle decompression is the act of taking a big fat IV catheter and sticking it into the chest on the affected side. (There are two landmarks in common use: between the 2nd and 3rd ribs, on a line drawn straight down from the middle of the clavicle, or between the 5th and 6th ribs, in line with the front border of the armpit. These are technically called the 2nd intercostal space (ICS) at the midclavicular line, and the 5th ICS at the anterior axillary line.

Needle decompression works by giving the air trapped in the pleura an effective way out.

The problem with needle decompression is that, especially with larger characters, it isn't necessarily effective. Oftentimes the needle is simply too short to reach the pleura, especially in larger characters with strong pectoralis muscles or fat deposits, including breasts. Other times the catheter may kink or get backed up with blood.

Definitive Treatment

Needle decompression has the potential to be a definitive treatment for the injury, but only if it's effective in the first place, and only if the needle is hooked up to some form of drain system to make sure that air can escape.

Surgery / Hospitalization

Diagnostics will include a chest X-ray and likely a chest CT, though if the character is in mortal danger, these will always take a back seat to a clinical diagnosis – i.e. by signs, symptoms, and history – and providers will treat first and image later.

The definitive treatment for tension pneumothorax is placement of a chest tube or pigtail catheter in the chest. A chest tube is a large, straight tube, while a pigtail catheter is of a smaller diameter and is curled, like a pig’s tail.

Both are simple, quick procedures in the ER. They both involve putting a tube into the chest at the 4th or 5th intercostal space (between the 4th–5th or 5th–6th ribs) vertically aligned with the armpit (axillary line).

The end of the tube will have something called a Heimlich valve, which is a one-way valve (air can go out but not in).

Another option is a procedure called a finger thoracostomy. The surgical landmark is the same as for all other procedures, but the act is simpler and more brutal. The site is identified and the doctor — who is likely an ER physician — simply cuts down through the chest wall until they're touching lung. This is done in extreme circumstances, where the character is about to die. Otherwise, a chest tube or pigtail catheter is preferred.

In the Austere Environment

Characters who suffer a tension pneumothorax in extreme conditions are likely to die, unless a knowledgeable character with the correct equipment is around.

In settings before about 1950, the character is also likely to die, and they'll die gasping. Treatment of the tension pneumothorax requires understanding pressures inside the chest, which weren't readily measurable till then. Trauma surgery simply hadn't advanced to the point of understanding this rapidly lethal wound until that point.

The Rocky Road to Recovery

Capabilities Retained

Characters will retain the use of all four limbs and will be cognitively unaffected (barring brain damage from an extended period of low oxygen levels).

Disabilities: Temporary

Your character is likely to have a sensation of pressure at the catheter insertion site. Once the lung is reinflated, they can walk and perform most normal activities while the wound heals.

They will be instructed not to fly for six months after the pneumothorax. This is because altitude affects pressure and can cause reexpansion of the pneumothorax.

Disabilities: Permanent

Tension pneumothorax shouldn't cause any permanent disabilities, unless there are other complicating features of the injury.

Features of Recovery: Hospital Stay

Characters with no other complications, who respond well to the pigtail, can actually be sent home with the catheter in place. Characters with other injuries or who got bigger tubes will likely be admitted.

Features of Recovery: Aftercare

Characters will be instructed to walk up to their capacity, and increase their walking daily. They may want to use a pillow or other object to hold when they cough, because that can be painful.

If a character is sent home, they must come back for follow-up X-ray within 48 hours, to make sure the pneumothorax hasn't reexpanded.

The catheter should be removed after 3–5 days if no other issues arise.

Complications

Pigtail catheters are good for patients because they're smaller than chest tubes, which means they hurt less and can often be sent home in the patient.

Pigtail catheters are bad for patients because they're smaller tubes, which means that they might kink and then fail to vent out the air they need to get rid of.

Flying before the recommended date can cause another pneumothorax, though this is unlikely to be severe enough to collapse the lung again. However, the character might experience significant shortness of breath and exhaustion.

The New Normal

If the lung tissue itself wasn't damaged by the object, your character will return to their full function within 2–4 weeks. (No Disability)

If the lung was damaged by the injury, they may have other complications with the lung.

Future Risks

Even when they think they're healed, significant, rapid changes in altitude within the first 6 months could cause your character's pneumothorax to recur. No long-term risks are known.

Total Recovery Time (Typical)

Uncomplicated: 2–4 weeks

Complicated: Minimum 4 weeks but typically longer, depending on the damage

Sensory

Sights

The hole in the chest might be small, or it might be fairly large. Through a large enough hole, characters can see the injured's lung expanding and collapsing with each breath.

Sounds:

The wound may make a sucking noise as the character breathes. (This is known, appropriately, as a sucking chest wound.)

Medspeak

Tension pneumothorax is abbreviated in a chart as TPTx or TPx, and is colloquially known as a "tension pneumo."

Chest tubes are listed in various sizes; pigtails tend to be 12 French or 14 French, whereas chest tubes are larger: 24 Fr to 36 Fr. Pigtails are inserted over a guide wire, which is called the "Seldinger technique." They are held in place with a kind of stitching called "purse string" suture.

A TPTx that also has significant pooling of blood in the pleural space is a hemopneumothorax, or a "hemopneumo."

The landmarks are almost never said as "intercostal space," but referred to as the "ICS."

Key Points

· Tension pneumothorax is a rapidly lethal condition, developing from slight trouble breathing to deadly within minutes to an hour.

· TPTx collapses the lung and puts enormous pressure on the heart. It also kinks the great vessels.

· TPTx is treated by allowing the built-up air to escape. This is done with a needle, insertion of a tube, or cutting down until the lung can “communicate” directly with the outside world.

[sundrenched-smilez]

odd numbers for the lesbian asks! (if it's too many just do every 4th one maybe?)

1. Femme or butch? 

for type, im vry easily wooed by butches tbh

as for myself, im genderfluid + heavily lean towards butch-ish for one gender + have been gettin more comf w that term for myself. the 3 genders i switch between, ive described as sharp, dainty and tired, for reason of not really being comf w gender labels aside from nonbinary. sharp/tired r kinda butchish, moreso sharp. like leather jackets, ripped jeans, dress pants/shirts, defs flannels (which r a given for any mood im in tbh) while tired is like mb softer, more focused on flannels + loose tank tops/shirts, shorts + certain skirts, comfy clothes, and the like   

ive found that i’m leaning more towards butch lately too, like i’ve been a lot more comfortable with pants and a nice top than i have w dresses or most skirts + im wondering if i was just hanging on to femininity for sake of society, so those r things 2 think abt. i still feel comf in them sometimes, but it’s getting much less often. gender’s weird, i still cant cling to one bc of how pressuring that is so genderfluidity is still smth for me + it shifting to different percentages is okay (im thinking out loud @ this point, but its helping so i hope its interesting to read)

3. Plaid button-ups or leather jackets?

both, but primarily flannels/plaid buttion-ups

5. Describe your aesthetic

aaahh theres a lot of diff aesthetics i could go into, but i have a tag if ur interested in a visual representation? basically, cosy homes, forests, wooden steps and bridges, cats, girls/nbs, water, plants, and old video game stuff, and clouds/skies. i’m sure there’s more in there, but for a good rule of thumb !! as for like dressing aesthetic, i like to look rly gay + attractive and a lil showy? like my shorts r Short and i love crop tops + a lot of my shirts show my bra thru them, + i like showing it when i can, like sports bra + a tank top is a fav look of mine bc i can make it look like my bra is a trim on the shirt + it’s cute. i’ve been wearing dresses less often, but occasionally, i like to rock one. id love a pair of combat boots but i have like size 11/12 feet + most stores dont carry that size + im hesitant to buy some online. 

7. Favorite pair of shoes?

its rly hard to find any, i have like walmart converse knockoffs atm + theyre a beige/grey color im not that huge on, it kinda reminds me of sandalwood but depressed

9. Any haircut goals for the future? 

there was the undercut!! and i have that down now c: next step is to dye it blue and mb some purple. i wanna bleach it if i’m gonna dye it, but im hesitant to do that bc of how damaging it is, but since my hair’s been cut a cpl time almost all the color is out now, so i think itll b ok if i take good care of it. 

11. Describe the worst date you’ve been on

i went to a cafe w someone (i think they were nb but i cant remember, it was like 2 yrs ago about ) and they were impossible to talk to bc they just kept saying “im awkward sorry” @ everything and like any conversations i tried to maintain were all one-shot responses, and like that was a lil frustrating. like i dont hold it against them or anything, more in a sense of i was rly tryin 2 carry it and just couldnt 

13. If taken, talk about your girlfriend/wife!

whooh i wish i was taken, i need affection + to b cute w someone 

15. Describe your dream wedding

hmmmm i havent thought much about it !! i know when i was younger i wanted to wear a black wedding dress but now im thinkin mb a suit that switches to dress @ the bottom?? that could b cool. I’d be happy w anything tbh, if im getting married, i’d just b happy to be w my wife/spouse. mb somewhere in a forest or on a boat would b cool, defs lots of good food and colorful flowers. I’d like a lot of color, most weddings ive been to are just b/w and bland for my taste (they’ve also all been straight tho so theres that.) it’s kind of wild to think that i might b married someday, but it’d b rly nice. i just haven’t thought much abt the planning of one. it’d b rly gay tho, probs give out tiny gay flags at each seat, and the cake could b lesbian flag colors. im rly drawing a blank on this, but i know id want all my friends around the country + world to be there. 

17. If you could live anywhere in the world, where would you live?

i definitely want to live in a port town at some point !! idk where i’d like to settle down, ideally somewhere that doesnt get much hotter than 90 degrees + has lots of parks + is big enough for some events, like pride stuff, little festivals, a farmer’s market, and places to do things, such as a movie theater, bowling alley, mb an aquarium, if not one in a nearby town. hiking trails r also good. 

19. Favorite lesbian novel/story?

on a sunbeam!!! its a huge inspiration for me, and i love it so much. it always puts me in such a good mindset when i read it, and the artist is my age, so it makes me feel like I can also accomplish great things if i rly put my heart into it!! which is such a good feeling, and it has great representation + characters that i love, and its rly gay, and in space and theres ships shaped like fish + its gorgeous : D i could go on for hrs abt it + how important it is to me. theres an nb character too, and like the aspect of found families is one that rly hits home and it helped me get thru a rough time of my life + better accept myself as queer/gay. 

21. Favorite lesbian musician?

adult mom (tho i think they’re bi but still gay), or hayley kiyoko

23. Ever been assumed to be nothing more than a gal pal?

i think so, but i can’t place when, it’s been a bit. 

25. Be positive! What do you like most about being a lesbian?

talking abt being gay w other girls/nbs is lovely and cathartic, i never got to growing up bc i lived in a homophobic town + i was like dealing heavily with internalized homophobia and body/gender dysphoria so i was ace for a bit. talking more abt like sexual attraction + aesthetic attraction is new to me, and that’s been a process to get to, but it’s nice that I can now do so w/o being belittled or barraged by insult. i also just love the thought of being w someone, and daydreaming abt when that happens is really nice. also,, girls + nbs r a blessing and brighten my day and im so glad im attracted 2 them 

27. Turn ons?

absolutely communication, that’s a need. i had a bad experience w someone bc she wasn’t communicative at all, and failed to tell me that we weren’t dating despite us going on several dates + kissing??? like i wont go too into it, but hatchi matchi it was a mess. so yeah, communication, affection, and like reassurance that they actually want to be with me, and that my presence is wanted and enjoyed. I got a lot of “i dont care”s for answers last sort-of relationship, and that was rly discouraging. another turn on is for them to initiate talking and things, like holding hands or planning to hang out + such. consent is another big one. 

29. Do you usually ask other women out or do you wait for them to ask you?

i usually tend to ask them out, but im still dealing w internalized junk, so its difficult. i also havent any situations in which they liked me back, which is frustrating. like i got lead on earlier summer for abt a month until i asked what we were doing + didnt rly get an answer, and it was this whole mess. i generally try to make the first move tho, bc i know firsthand how difficult it is, but that being said, it’s still hard for me to know for sure if theyre interested + i dont wanna make things uncomf w them, so i’ll wait until i think there might b attraction. that being said, once that’s all out of the way, i like to consider myself a good flirt when im trying. 

31. Talk about your interests or hobbies!

i have lots of interests!! im obsessed w steven universe, its my fav show (and if u ever have time, we should totally watch it together sometime, i rly think you’d love it, it’s super gay + heartwarming.) i really love playing music and learning new songs, which im rly great at memorizing. talking to friends + gettin 2 know them better is always nice and fun. i like to draw new things + see the different ways ppl draw, so seeing art on here is always fun for me. i’m also rly into polygon videos (it’s a youtube channel, not like videos abt polygon haha) and this podcast called the adventure zone. season one just ended, so i might start listening to another one called friends at the table. i rly wanna start a podcast w someone, but can never find anyone to start it with. idk what I’d talk abt but if i could find a partner for it, i think it’d be a lot of fun. mb smth abt games or books/queer representation in media. doing a dnd podcast would also b rly fun, but a lot of work + editing so mb later down the road !! im blanking on other interests atm, but animations and cartoons r lovely and i aim to make something in that field one day, if not just a comic.

my hobbies r mostlyyyy drawing, dnd things now every thursday, hanging w my friends, playing video games, sometimes writing (i rly wanna start a comic, and im tryin to get my butt into gear on it), goin to parks, listening to music, and goin 2 events w roe + cesar, two of my friends. sometimes ill play music!! i need to get more than the keyboard i’m lending, but i love performing. ill also watch leg birds on youtube, theyre a lesbian couple that plays gams + theyre rly sweet. 

33. Do you love easily or does it take time for you to warm up to someone?

its easy for me to love friends, doesnt usu take me more than a few months of knowing them if were talking a lot. as for falling in love, that takes me a lot longer. ive never rly been in love w someone. i thought i was once, but rly it was just my first gay experience w someone and i wanted it to be perfect so i projected a lot of things + made it better than it seemed to myself for the duration of it, which wasn’t healthy, so i wanna avoid doing that again, + take things slower next time. or at least for what they are. 

35. Ever fallen for a straight girl?

a few times, they were just crushes tho, so it wasnt too too bad

37. Favorite comfort food?

hot cocoa or tea. as for food food, i dont think i have one. mb french toast or cinnamon rolls. 

39. Vegetarian? Vegan? None of the above?

i used to be a vegetarian!! for like a yr, but it was difficult for me to eat and feel full, and i was pretty underweight, so i stopped. 

41. Early-riser or night-owl?

both, i tend to stay up, but getting up early can be nice if i dont have to do anything. like just gently waking + making some tea and a nice breakfast + sittin around for a bit. 

43. What is your Myers-Briggs type?

enfp-a 

45. At what age did you know you were a lesbian?

i think like 16-17? it took me a bit to get words for identity, like lesbian/nonbinary and the like, but i always knew, like id call myself an individual as opposed to gendered terms that i was referred to, and always felt rly yucky w deadname + the wrong pronouns

47. Are you crushing on anyone at the moment (celebrity or otherwise)?

ive got one crush atm !! and another person who seems nice, but i wanna hang out w before like thinking abt a crush (im poly, which perhaps goes w/o saying, but i always like to state it when talking abt these things, jic )

49. Talk about your dreams/aspirations for the future

i’d like a partner or two, to get some bongos- i got to play some a couple weeks ago, and it was the most fun i’ve had playing anything!! having smth with an instant response that i could make up rhythms with was really rewarding and so much fun. i know i want a cat at some point, to go on cute dates + cuddle and kiss a lot w someone, to visit my friends in other places, dye my hair, get a better job, to travel a bit, make a comic, go to college for animation and storyboarding, mb go to camp at some point, and I’d like to make some more friends here, i’m already making some, which i’m super happy about, but it’s always nice meeting new ppl 

thank u for asking!! this was relaxing + fun, and a lot of the topics were cathartic to talk about, and i needed it. so thanks for listening too kinda

also im queen of commas, i’ve discovered while typing this