Fallacy In Examining The Chest With Gloved Fingers In The Emergency Room

It is a normal and accepted practice to examine trauma patients in the emergency department by wearing gloves as a part of universal precautions. The important sign of hyper-resonance on percussion of the affected side of the chest in a case of pneumothorax is emphasized in many medical textbooks. The importance of this sign differentiates a tension pneumothorax from cardiac tamponade and necessitates insertion of a chest drain even before taking an x ray. We report a case where the signs of pneumothorax and surgical emphysema were missed in the emergency room while examining the patients with gloved fingers and revealed when the patient was re-examined without gloves.