Chest tube in an existing wound

[rmabrey]

Has anyone ever seen a chest tube inserted into an existing wound? To paint the picture, it was a knife wound to the upper left lung.

My biggest question is why? particularly since the Pt would obviously need surgery there.

 

[Veneficus]

Has anyone ever seen a chest tube inserted into an existing wound? To paint the picture, it was a knife wound to the upper left lung.

My biggest question is why? particularly since the Pt would obviously need surgery there.

The patient may not need surgery.

If there is a usable hole, why make another?

 

[abckidsmom]

Has anyone ever seen a chest tube inserted into an existing wound? To paint the picture, it was a knife wound to the upper left lung.

My biggest question is why? particularly since the Pt would obviously need surgery there.

To facilitate drainage of blood, fluid and air from the pleural space.

 

[rmabrey]

The patient may not need surgery.

If there is a usable hole, why make another?

Good point I guess. Just something neither I, my partner, or my Sup had ever seen before. Though im pretty sure she was going to surgery at some point, but I dont think she made it that far.

To facilitate drainage of blood, fluid and air from the pleural space.

I know why a chest tube is inserted. I just didnt know why there.

 

[Veneficus]

Good point I guess. Just something neither I, my partner, or my Sup had ever seen before. Though im pretty sure she was going to surgery at some point, but I dont think she made it that far.

Dead people do not need surgery

From your description, I was not willing to stipulate how serious the wound was or what was involved.

Sometimes a wound to the chest cavity does not actually penetrate the lung.

A wound involving most of the structures of the hilum does not routinely get saved.

I know why a chest tube is inserted. I just didnt know why there.

Chest tubes for drainage can be situated anywhere in the chest cavity depending on the need.

For example post bypass surgery, they are usually inserted anteriorly on each side of the sternum.

 

[rmabrey]

Dead people do not need surgery

From your description, I was not willing to stipulate how serious the wound was or what was involved.

Sometimes a wound to the chest cavity does not actually penetrate the lung.

A wound involving most of the structures of the hilum does not routinely get saved.



Chest tubes for drainage can be situated anywhere in the chest cavity depending on the need.

For example post bypass surgery, they are usually inserted anteriorly on each side of the sternum.

I guess thinking about it more the 'Why make another hole when one exist" line is pretty spot on. Both my partner and the sup being former helo medics and just from what I have managed to see are all used to seeing the "safe triangle". Kind of caught us off guard

 

[Veneficus]

I guess thinking about it more the 'Why make another hole when one exist" line is pretty spot on. Both my partner and the sup being former helo medics and just from what I have managed to see are all used to seeing the "safe triangle". Kind of caught us off guard

You can learn a lot from a dummy.

 

[zmedic]

I'm going to disagree with the "chest tubes anywhere" philosophy. You have to remember that what most of us think of as the "chest" is based on what you can see from the outside. But with a deep expiration that liver comes pretty high up. That's why chest tubes are typically put over the 4th or 5th rib. Also you are trying to get the tube up towards the apex of the lung.

Note that in cardiac surgery when they are putting in anterior chest tubes they are placing them from the inside (since the chest is open with a median sternotomy) to the outside. So there is no guessing about where the organs are.

Here's my take on existing wounds. First of all they have some sort of track, you don't know where that track goes. So I like the tracks that I make myself with my foreceps. Secondly, that stab wound is a dirty wound that should be explored and washed out, either in the ER or OR. If you are putting a chest tube in through that hole you are pushing whatever bacteria is in there deep into the chest, and that wound will stay open until the chest tube is taken out.

I don't really see that using an existing hole will save you much time, how long does it really take to cut 2cm of skin? And if the patient is stable you still need local lidocaine, since what really hurts is the spreading of the intracostal muscles.

 

[Veneficus]

I'm going to disagree with the "chest tubes anywhere" philosophy. You have to remember that what most of us think of as the "chest" is based on what you can see from the outside. But with a deep expiration that liver comes pretty high up. That's why chest tubes are typically put over the 4th or 5th rib. Also you are trying to get the tube up towards the apex of the lung.

I am not everyone.

Note that in cardiac surgery when they are putting in anterior chest tubes they are placing them from the inside (since the chest is open with a median sternotomy) to the outside. So there is no guessing about where the organs are.

Here's my take on existing wounds. First of all they have some sort of track, you don't know where that track goes.

I think it is a judgement call of the surgeon.

Secondly, that stab wound is a dirty wound that should be explored and washed out, either in the ER or OR. If you are putting a chest tube in through that hole you are pushing whatever bacteria is in there deep into the chest, and that wound will stay open until the chest tube is taken out..

I don't dispute it has to be cleaned, before the chest tube would be ideal. But let's face it, if you are putting a chest tube in to collect/measure blood, or even as a temporary stabilization method, once you open the chest in the OR, you can do what you need without much problem.

If you are going to just clean it in the ER, then go for it.

Toss in your antibiotics and be done.

I don't really see that using an existing hole will save you much time, how long does it really take to cut 2cm of skin? And if the patient is stable you still need local lidocaine, since what really hurts is the spreading of the intracostal muscles.

It is not always about time.