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:
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):
Bottle 1
Bottle 2
Bottle 3
If you can bear the advertisational tone, this video shows how to setup an Atrium drain:
Atrium drain
Chest drain removal
Don’t need that tube anymore? Michael McGonigal shows how he takes out a chest tube:
ICC removal (McGonigal)
CLINICAL CASES
Resus Room Reflection
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC