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…
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:
Needle decompression (McGonigal)
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:
ICC insertion (McGonigal)
Because repetition is the key to learning, here’s another video demonstrating ICC insertion on a dummy, and connection to a Pleur-evac UWSD:
ICC insertion (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:
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:
ICC removal (McGonigal)
Resus Room Reflection