CCEMT-P SM Aug-131

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CHEST TUBES

• When to Use or Not Use
• By Don Hudson D.O.

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Chest Tubes

• Indications and purpose
• drainage of fluid and air from pleural space or
  mediastinum
• used to treat pneumothorax, hemothorax,
  hemopneumothorax and empyema (pus)
• useful in fluid collection
• helpful in respiratory assistance

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Positioning
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Chest Tube Insertion

• Site
• Procedure

. Complications
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Assessment of Chest Tubes

• Respiratory effort and status
• Suction versus water seal method
• Tube placement
• intact dressing
• sutures
• signs of infection
• loss of tube integrity

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X-Rays
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Now What ?
X-Rays
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Assessment of Chest Tubes

• Adequate drainage
• quality and amount
• color changes, blood, pus
• Adequate suction
• maintain dependent loop
• milking chest tube
• placing on water seal
• adjustments

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Do these Work ?
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How Good are the Small Tubes ?

• When can you use a Himlick valve ?
• Why would you use it ?
• What can you reasonably expect it to do ?

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Complications of Chest Tubes

• Recurrent pneumothoracies
• Accidental removal
• immediately apply occlusive dressing to site
• do not reinsert tube
• monitor vital signs closely
• ventilate prn
• consider diversion to appropriate facility

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Complications of Chest Tubes

• Broken collection chamber
• loss of suction
• can cause open pneumothorax

. USE IN AIRCRAFT
. UNIVERSAL PRECAUTIONS
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Chest Tubes
ATER INSERTION NOW WHAT ? WHO DO YOU ANSWER TO
? WHAT TRAINING IS APPROPRIATE ?
Chest tubes scare everyone
Conclusion
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• Some times you really dont know if you are
  coming or going but for now were done. Thank
  you for your attention.