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. Repeat chest x-ray was performed afterwards exhibiting the following..

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

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

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

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

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

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.

- link for pneumothorax calculator