Chest Tube Placement -- Messy

Chest tube placement in Haiti in not so ideal conditions. Best with what we had.

Category:

Nonprofits & Activism

Tags:

• chest tube
• haiti
• blood
• empyema

[FatGoiter]

Now we know where Florida Orange Juice comes from :)

[TheDocTipu]

@FatGoiter . :)



[TheDocTipu]

@Moonbopper. Thanks your for your two cents. I agree that the data is lacking and mostly anecdotal

Regarding the discussions - this was in an international setting with many learners so there was a lot of side conversations going on - not ideal in the ideal setting.  Thanks.

[TheDocTipu]

@laylaindy: We do use local anesthesia. Lidocaine is injected over the lung and that helps reduce the pain level significantly. We also tend to give some sort of relaxant or conscious sedation to help. You can't see it that well in the video but she was given light conscious sedation by a nurse anesthetist so she shouldn't remember anything that happened.

Does that help?

[TheDocTipu]

Good point - usually though for an empyema as long as you keep on suction you can take off a good 1.5 to 2L through chest tube. Usually with a thoracentesis we say 1.5L as I'm sure you know but with a chest tube on suction I've seen up to 3L taken out at one time then put on suction. We ended up taking out about 1.5-2L then put it up to continuous suction for the rest.

Thanks for the good teaching point.

[petcal2004]

GREAT!!! Thank you!

[ryandsucks]

Wow. I know it was done in Haiti, and probably under less than ideal circumstances, but did you get to look at a pre and post CXR?I bet there was a lot more black!

[vixenxoxo82]

I had a pneumothorax that required a chest tube after knife wounds to the chest. I was half-conscious, in and out, in the ER when they initially inserted it. However, a couple days later, somehow their amazing job came undone and my tube came out of my chest, causing my lung to collapse yet again. So I had to endure another emergency tube insertion. It was no fun.

[MrOddhead]

It's amazing how much exudate was in there. Kinda cool watching it move up and down within the tube as the patient was breathing.

[MrNnssvv]

Without clamping the tube what a mess, you should have sterile specimen bottle for culture and sensitivity test, and only 1liter initially to drain to prevent re expansion pulmonary edema. You infusing pneumothorax

[Moonibopper]

There is no good data supporting a clear correlation between amount of fluid taken off and risk of reexpansion pulmonary edema. Also, just an opinion... but I feel that all the extra live commentary and side discussions are unwarranted while the ill patient is under the drapes.