Chest Drain Insertion in Adult Trauma

Which one of the following patients has clear indication for chest drain insertion in the ED?

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.

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?

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?

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?

Examine this chest x-ray.

Which of the following statements are correct?

Which of the following statements regarding antibiotic cover following chest drain insertion in injured patients are correct?

In which one of the following scenarios is clamping the chest drain appropriate?

Which of the following reliably indicate that the chest drain lies within the chest cavity?

Which of the following statements regarding the National Patient Safety Agency report on the risks of chest drain insertion are correct?