4.2 Chest Drain

Question 1

Type of chest trauma

Answer 1

Blunt trauma
Penetrating trauma

Question 2

Pneumothorax formation

Answer 2

Presence of air accumulate in pleural area,
separate visceral and parietal parietal pleura,
Lung recoil and chest wall move outward.
Alveoli are compressed

Question 3

Type of pneumothorax

Answer 3

Closed
Open

Question 4

Type of pneumothorax (etiology forms)

Answer 4

Spontaneous
Traumatic
Iatrogenic

Question 5

Difference between primary vs secondary spontaneous pneumothorax

Answer 5

Primary: without underlying causes
Secondary: with (COPD)

Question 6

Manifestation of spontaneous pneumothorax (On affected side)

Answer 6

Hyperresonant percussion
SOB with decrease breath sound
Lack of movement

Question 7

Traumatic pneumothorax: SCW

Answer 7

Sucking chest wound

Question 8

Example for latrogenic pneumothorax

Answer 8

Lung biopsy,
thoracenthesis
Insertion of CVC
Insertion of central line

Question 9

What is tension pneumothorax

Answer 9

Air keep trapping in the pleural space
Increase in intramural pressure in affected side
The trachea, heart great vessel shift to unaffected side
= Mediastinal shift

Question 10

Mediastinal shift:

1. Place a ____ on in ________
   Reduce ______
   Reduce ______
   Hy
2. Lung _____ (affected side), ______ (unaffected side)
   Hy

—>

Answer 10

The trachea, heart great vessel shift toward unaffected side

1. Place a torsion on in inferior vena cava
   Reduce venous return
   Reduce cardiac output
   Hypotension
2. Lung collapse (affected side), compressed (unaffected side)
   Hypoxemia

—>compromises CV and respiratory function

Question 11

Management of pneumothorax

Answer 11

Pleurodesis癡肺

Question 12

underwater seal drainage

Answer 12

Pneumothorax
Hemothorax

Question 13

Underwater seal drainage purpose

Answer 13

Drain air/fluid/pus/blood from pleural cavity
Facilitate re-expansion of lung
Restore negative intramural pressure

Question 14

Insertion site for
Apical pneumothorax
Hemothrax

Answer 14

-2nd intercostal space (mid-clavicular line)
-4-5th intercostal space (anterior or mid-axillary line)

Question 15

Indication for removal of chest drain

Answer 15

Lungs are reexpanded as shown on chest radiography

Question 16

indication of Persistent bubbling in underwater seal fluid chamber

Answer 16

Continuing bronchi-pleural air leak

Question 17

Clamping of chest drain tubing

Answer 17

Do not clamp bubbling chest drain
Do not clamp the tube without order
Only clamp when
- changing the bottle
- control rate of drainage for large pleural effusion
- assess readiness of chest tube removal