Chest Drain Insertion in Adult Trauma

2 Topics

Attaining Competency

Indications for Chest Drain Insertion

6 Topics

5 Topics

Kit Preparation

8 Topics

Technique Introduction and Checklist

Infiltrating Local Anaesthesia

Incision and Blunt Dissection

Inserting the Drain

Fogging of the Tube

Securing the Drain

Post-procedural Care

3 Topics

Chest Drain Insertion in Adult Trauma

Chest Drain Insertion in Adult Trauma

Chest Drain Insertion in Adult Trauma Chest Drain Insertion in Adult Trauma

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Question 1 of 10

1. Question
Which one of the following patients has clear indication for chest drain insertion in the ED?
- A 19-year-old man stabbed in the right side of his chest posteriorly with a moderate sized pneumothorax
- A 35-year-old man who has fallen 8m with fractured ribs 5-7 on the left side. His chest x-ray is otherwise unremarkable. The injury appears isolated, though he does have respiratory distress, possibly because of pain
- A 26-year-old male with a small haemothorax secondary to a rib#, detected on CT
- A 46-year-old woman with an occult pneumothorax detected on CT. There is no current plan for her to be ventilated
- A 74-year-old woman with a small isolated traumatic pneumothorax following a road traffic accident
Correct

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Question 2 of 10

2. Question
A 64-year-old woman has fallen off her horse. You elicit crepitus over her left ribs laterally. Her chest x-ray confirms fractured left fifth and sixth ribs with an associated moderate haemopneumothorax.

Which of the following are safe landmarks for chest drain insertion given this information.
- Second intercostal space, mid clavicular line
- Fourth intercostal space midaxillary line
- Fifth intercostal space more anteriorly
- Seventh intercostal space mid axillary line
- No landmark is required. Opt for conservative management, observing her carefully
Correct

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Question 3 of 10

3. Question
A large 84-year-old woman has fallen down the stairs. Her injuries are a moderate haemopneumothorax right side, a fractured right wrist requiring manipulation and a skin flap laceration to her left tibia. There is no indication of a head injury.

Which of the following are reasonable options in pre-emptively relieving the pain and anxiety of chest drain insertion?
- Lignocaine, up to 3 mg/kg
- Titrated IV midazolam
- Titrated IV morphine
- Entonox
- IV midazolam and morphine
Correct

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Question 4 of 10

4. Question
You proceed to insert a chest drain into the same 84-year-old woman. Having anaesthetised the skin, you fail to aspirate air or blood when inserting a 21G needle perpendicular to the skin in the fifth intercostal space, midaxillary line.

Which of the following might account for this?
- Misjudgement of the true site of the fifth intercostal space
- Her thick chest wall
- Misinterpretation of the chest x-ray
- Occlusion of the needle with tissue from passage through the chest wall
- A non-perpendicular route through the chest wall
Correct

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Question 5 of 10

5. Question
You are supervising a junior doctor inserting a chest drain into a 70 kg man with a large traumatic pneumothorax. The doctor asks how far to insert the chest drain? What is your response?
- Insert the chest drain halfway
- Insert all the way, leaving enough room to secure the drain
- Insert the chest drain in sufficiently, so that the proximal hole of the chest drain lies within the pleural cavity
- Insert the chest drain until the patient tells you it's become uncomfortable
- Insert 15 cm into the patient's chest
Correct

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Question 6 of 10

6. Question
Examine this chest x-ray.

Which of the following statements are correct?
- The drain is clearly within the pleural cavity
- The drain appears appropriately placed in order to drain the haemothorax
- The drain lies within a fissure
- The drain appears to have been inserted to the appropriate length
- The drain is not within the pleural cavity
Correct

Incorrect
Question 7 of 10

7. Question
Which of the following statements regarding antibiotic cover following chest drain insertion in injured patients are correct?
- The empyema rate following chest drain insertion in injured patients without antibiotic cover is between 5 and 10%
- 24-hour IV cephalosporin cover provides statistical, but not clinically relevant effect
- 24-hour IV cephalosporin cover reduces the empyema rate to <1% with an NNT <6
- 24-hour IV cephalosporin cover reduces the empyema rate to <1% with an NNT 10-40
- 24-hour IV cephalosporin cover reduces the empyema rate to <1% with a NNT >40
Correct

Incorrect
Question 8 of 10

8. Question
In which one of the following scenarios is clamping the chest drain appropriate?
- Sudden deterioration in oxygen saturation
- Patient transfer
- Chest drain not swinging
- Abrupt and continuous blood loss resulting in profound clinical deterioration
- Contrast phase of CT imaging
Correct

Incorrect
Question 9 of 10

9. Question
Which of the following reliably indicate that the chest drain lies within the chest cavity?
- Fogging of the drain
- CT chest
- Chest x-ray
- Swinging of the chest drain with respiration
- Improving clinical status
Correct

Incorrect
Question 10 of 10

10. Question
Which of the following statements regarding the National Patient Safety Agency report on the risks of chest drain insertion are correct?
- The injuries described are confined to the traditional method of chest drain insertion, rather than Seldinger
- Poor patient positioning and inappropriate site of insertion are two key errors resulting in patient harm
- Written consent is recommended
- Ultrasound guidance for haemothoraces is recommended
- The most common cause of death attributed to poorly performed chest drain insertion is puncturing a major organ.
Correct

Incorrect

5 Comments

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Saeed Alam Khan April 24, 2024 at 8:44 pm

Good learning

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Dr Duminda Lalana Samarawickrama, Specialty Doctor July 1, 2024 at 11:12 am

Great one

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Dr Imadeldin Ahmed Mohamed Tahir July 8, 2024 at 4:49 pm

beneficial course

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Dr Elaine Karen Mellor July 26, 2024 at 11:49 am

Good revision

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Miss Ruth Anne Draper August 22, 2024 at 9:55 pm

Good revision

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