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Interactive Case Discussion #12

Interactive Case Discussion #12. Kerby Chloe A. Go. CASE 12. 50/M Came in from another institution with severe difficulty of breathing. He came in with a chest x-ray done outside and when your resident saw the film, the patient was immediately referred for surgical management.

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Interactive Case Discussion #12

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  1. Interactive Case Discussion #12 Kerby Chloe A. Go

  2. CASE 12 • 50/M • Came in from another institution with severe difficulty of breathing. He came in with a chest x-ray done outside and when your resident saw the film, the patient was immediately referred for surgical management. • Repeat chest x-ray was performed afterwards exhibiting the following..

  3. Chest tube Insertion • inserted to drain blood, fluid, or air and to allow the lungs to fully expand • Indication: • Pneumothorax • Tension pneumothorax • Hemothorax • empyema

  4. Procedure • Point of insertion: anterior axillary line • Aseptic technique and local anesthesia is applied • The free end of the tube is usually attached to an underwater seal below the level of the chest

  5. Pneumothorax • Collection of air or gas in the pleural cavity of the chest • May occur spontaneously or with physical trauma, blunt injury/trauma, or as complication of medical therapy • Presents as dyspnea in most cases

  6. Tension pneumothorax • If the penumothorax leads to oxygen shortage and low blood pressure, progressing to cardiac arrest

  7. Pneumohydrothorax • Air or gas with fluid in the pleural cavity • Caused by: • Infectious • TB • Neoplastic • Mesothelioma • Anatomic, foreign body or structural disorders • Perforated/ruptured esophagus

  8. Common clinical surgical rule: pneumothorax greater than 25% requires chest tube drainage • Air slowly resorbs from the pleural space at a rate of approximately 1.5% / day. This rate will increase with use of supplemental oxygen.

  9. www.chestx-ray.com/calculator/ptx.html - link for pneumothorax calculator

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