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Outline Cases Background Anatomy Pathophys How work Indications ACEP guidelines PICO Papers Conclusions
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Braden McIntosh EBM: Chest Tubes Outline Cases Background
Anatomy Pathophys How work Indications
ACEP guidelines PICO Papers Conclusions Case 1 60 obese M, high
speed MVC, no SB, complaining of chest pain and sob.Exam shows
decreased breath sounds on right and trachea deviated to the left.
Case 2 18 y/o F stabbed by angry bf in the right chest complaining
of shortness of breath. US shows the following: Background Chest
tubes are the #1 intrathoracic intervention in chest trauma
Procedure everybody needs to know how to do Anatomy Pathophys Chest
tube function Indications Blunt trauma and penetrating trauma
resulting in PTX or hemothorax Pleural effusion Malignant Effusions
Empyema drainage Spontaneous PTX Placement We all learned 5th
intercostal space ant axillary line
Triangle of Safety Direction Posterior placement Direction Failure
Failure continued DOES IT MATTER? PICO Population Intervention
Comparison Outcome
Population- M&F 18-65, trauma Intervention- tube thoracostomy
Comparison- placement Outcome- residual effusion/ drainage/
mortality/ hospital los/ need for further intervention Critical
Appraisal Design? Methods appropriate? Bias?
Statistical Analysis correct? Do data justify conclusions
Objective, independent and balanced? Relevance? Add anything new?
Paper 1 J. Trauma and Acute Care Surgery, Feb 2015 Question: see
title
Study type:retrospective 291 patients (8186 screened, 862 tube, 571
died or ed thoracotomy or not ct) Inclusion criteria: all pts
receiving chest tube 2/2 trauma as part of initial managementwho
had a CT showing position of the chest tube Definitions: based on
end of tip could be anterior, lateral, or posterior placement
(60degrees), and high or low (6th rib), tubes placed in fissure
recorded as such Removal determined clinically or by absence of
airleak, radiographic resolution, drainage 190 traumatic ptx >
(115 excluded for arrest or occult ptx) > 75 pts Inclusion
criteria: traumatic pneumothorax on cxr Methods:Placed ant axillary
line and directed anteriorly or placed mid axillary and directed
posteriorly based on clinical findings Definitions/ outcomes:
functional malposition defined by residual ptx requiring
repositioning or another tube inserted Stats:used Chi^2 for
univariate and paired t testing w/ p
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