chest drains

Question 1

A quarter of trauma-related deaths in

the United Kingdom can be attributed t

Answer 1

thoracic injuries

Question 2

Thoracic trauma types

Answer 2

penetrating (gun shot) and blunt trauma (crush)

Question 3

he majority of these injuries can be managed

without radical surgical intervention and with

Answer 3

appropriate chest drain management. In-hospital patients
requiring chest drain placement and management can
range from post-operative general surgical or cardiac
patients to those with general medical or respiratory
conditions

Question 4

The role of a chest drain is

Answer 4

to drain the pleural space
and restore the negative intra-thoracic pressure necessary for lung expansion.
Usually, the contents requiring
draining are air or blood but they may include chyle,
empyema, and gastric or oesophageal contents.

Question 5

In the trauma patient, the primary aim of a chest

drain

Answer 5

is to avoid mortality secondary to hypoxia, hypovolaemia, and cardiac or pulmonary injuries

Question 6

post-thoracotomy patient, chest drains are placed to

Answer 6

avoid development of a pleural collection and to aid

lung expansion

Question 7

In the post-cardiac surgery patient,

drains are placed to

Answer 7

.avoid pleural and mediastinal collections, allow assessment of ongoing bleeding and to
avoid tamponade in the presence of such bleeding.

Question 8

. Bilateral chest

drain insertion may be a requirement

Answer 8

n the unstable
polytrauma patient. Chest drain insertion is indicated
in any patient who has developed a pneumothorax and
requires positive pressure ventilation, general anaesthesia, and intubation or transport.

Question 9

Pre-hospital chest

tube placement has been associated with

Answer 9

associated with similar infection rates to emergency room tube

Question 10

a review of casualties

from the Vietnam War showed that 3%–4% of casualies died secondary

Answer 10

to a tension pneumothorax and
these soldiers may have been helped by a battlefield
chest drain insertion.

Question 11

Contra-indications for chest drain

insertion

Answer 11

Differentiation between a pneumothorax and bullous
disease should be made before chest drain insertion.
This may require careful and thorough radiological
investigations.
In cases of complete unilateral ‘white out’ on chest
radiography, differentiation should be made between
consolidation and pleural effusion or haemothorax
before chest drain insertion. In these cases, an ultrasonographic assessment may be useful