Tube Thoracostomy Part 1

01/17/22 • 47 min

Dr. Sean Stuart joins Claire and Morgan for the first in a two-part series about chest tubes. Dr. Stuart is a Navy emergency medicine physician and is the Research Director of the Combat Trauma Research Group.
This first episode covers a lot of ground, from a detailed discussion of the procedure itself to a thorough exploration of a recent paper contrasting the efficacy of traditional chest tubes against pigtail catheters.
Dr. Stuart calls out a couple important pearls, notably that oxygenation status is a very late finding for tension hemo/pneumothorax, and separately, that breath sounds are unreliable in determining whether a patient has this type of injury.
A recent paper gets some attention in this episode, and really illustrates why it's important to dig deeper than the abstract and conclusion:

Kulvatunyou, N., Bauman, Z. M., Zein Edine, S. B., de Moya, M., Krause, C., Mukherjee, K., Gries, L., Tang, A. L., Joseph, B., & Rhee, P. (2021). The small (14 Fr) percutaneous catheter (P-CAT) versus large (28-32 Fr) open chest tube for traumatic hemothorax: A multicenter randomized clinical trial. The journal of trauma and acute care surgery, 91(5), 809–813.

You can find this paper through your free (to the military) institutional login via OpenAthens. There's also a good summary at criticalcarenow.com.
Have a listen and let us know what you think!

Kulvatunyou, N., Bauman, Z. M., Zein Edine, S. B., de Moya, M., Krause, C., Mukherjee, K., Gries, L., Tang, A. L., Joseph, B., & Rhee, P. (2021). The small (14 Fr) percutaneous catheter (P-CAT) versus large (28-32 Fr) open chest tube for traumatic hemothorax: A multicenter randomized clinical trial. The journal of trauma and acute care surgery, 91(5), 809–813.

You can find this paper through your free (to the military) institutional login via OpenAthens. There's also a good summary at criticalcarenow.com.
Have a listen and let us know what you think!

Previous Episode

Spinal Immobilization

We all learned it.
We've all done it.
And we (mostly) all know that it's wrong.
Dr. Seth Collings Hawkins joins Trevor and Claire to discuss spinal immobilization. Rigid immobilization of trauma patients is entrenched dogma, but we've probably all heard that this procedure is not just without benefit, but is in fact harmful to our patients. Dr. Collings Hawkins is a leader in the wilderness EMS community, and he breaks down the reality of spinal immobilization and how we can all do better. Listen up as he talks about the history of this intervention, discusses appropriate uses for the rigid backboard and c-collar, and then shows how we can do better. This is important information for everyone to hear, from new medics to experienced flight surgeons. Have a listen and let us know what you think!

Next Episode

Tube Thoracostomy Part 2

Dr. Sean Stuart finishes up a discussion on chest tubes with Claire and Morgan.
This episode discusses some of the finer points of the procedure. Dr. Stuart also describes how to make an inexpensive task trainer so you can practice thoracotomies at your unit. Finally, he describes an improvised Heimlich valve that you can make with an exam glove if you're in a pinch and don't have a chest drain system immediately available. Photos on our website!
Have a listen and please let us know what you think!