- Joined
- Jun 22, 2004
- Messages
- 556
- Reaction score
- 635
case from call last night. unhelmeted motorcycle passenger thrown from bike. nasty depressed skull fx, SDH, lots pf edema/midline shift, pupils mid-position and minimally reactive. also has small traumatic right pneumothorax, shown on CT. trauma surgery places a right SC triple lumen after the CT and patient comes emergently to OR with like 5 minutes heads up. I get the case started, but hand off to my partner pretty much right away as I've been up all night and it's time to go home.
Anyway, my question is would folks normally have a chest tube placed in a patient with a (small) pneumothorax who you are paralyzing and planning to positive-pressure ventilate , likely for a prolonged period? I brought this up to the trauma guy who took the patient in the ED, and he was like "huh. I guess I could've placed a chest tube". at this point we're prepped and draped and operating, so i've marked the 2nd intercostal space and listen to breath sounds every time the pressure starts to drift, but I feel like trauma kind of dropped the ball on this one. am I being too conservative? Any thoughts?
Anyway, my question is would folks normally have a chest tube placed in a patient with a (small) pneumothorax who you are paralyzing and planning to positive-pressure ventilate , likely for a prolonged period? I brought this up to the trauma guy who took the patient in the ED, and he was like "huh. I guess I could've placed a chest tube". at this point we're prepped and draped and operating, so i've marked the 2nd intercostal space and listen to breath sounds every time the pressure starts to drift, but I feel like trauma kind of dropped the ball on this one. am I being too conservative? Any thoughts?