Own the Chest Tube!

aka Ruling the Resus Room 009

By now you’re all familiar with this ‘Own the whatsit!’ series. LITFL trawls the web looking for the best online video resources dealing with a particular emergency procedure or problem, pulls them all together and serves them up on a platter for general consumption.

This time round, we’re going to ‘own the chest tube!’ — as well as the chest drain and a few other things along the way…

Needle decompression

Whoa! A tension pneumothorax! We need to perform perform needle decompression of the chest quick-smart… Here’s how Michael McGonigal from The Trauma Professional’s blog does it:

But, hang on a sec, perhaps we shouldn’t be using that needle after all… Listen to Scott Weingart’s take on this in Needle versus Knife II: Needle vs. Finger Thoracostomy.

Intercostal catheter insertion

Now it’s time for the chest tube. Here’s Michael McGonigal again with his approach for chest tube insertion in trauma:

Because repetition is the key to learning, here’s another video demonstrating ICC insertion on a dummy, and connection to a Pleur-evac UWSD:

Of course, these days for pneumothoraces and pleural effusions we tend to use the Seldinger approach. Those pigtail catheters can be a bit tricky if you’re not familiar with all the parts. Check out this video demonstration of a pigtail catheter with obturator:

Other useful online resources include:

• Ernest Wang: Cook Medical 12 French Tube Thoracostomy Insertion Video.
• NEJM’s video on tube thoracostomy (requires subscription).

Chest drains and Heimlich valves

Got the tube in, now what? Gotta connect it to something!

But first, are you sure you understand how a 3-bottle system chest drain works? (The action starts at about 40 seconds in):

If you can bear the advertisational tone, this video shows how to setup an Atrium drain:

Chest drain removal

Don’t need that tube anymore? Michael McGonigal shows how he takes out a chest tube: