Chest surgery

examination sheets

Dr. Ziad Tariq

Steps of chest tube insertion

• Review indications and contraindications
• Explain and obtain consent
• Check side
• Exposure
• Position
• Mark site
• Sterilization, scrubbing and drapping
• Local anesthesia

• Incision

• Dissection
• Chest tube insertion
• Connecting to underwaterseal
• Assess function
• Fix in position
• Sterilize and dress
• Check up chest x-ray


Indications
Pneumothorax
Hemothorax
Hemopneumothorax
Chylothorax
Empyema
Recurrent or malignant Pleural effusion
Post thoracotomy

Contraindications

Coagulopathy
Pulmonary bullae
Pulmonary, pleural, or thoracic adhesions
Loculated pleural effusion or empyema
Skin infection over the chest tube insertion site

Complications of chest tube

• Pain
• Infection
• Bleeding
• Pneumothorax
• Surgical emphysema
• Malposition
• Trauma
• Lung collapse after removal
• Slipped tube
• obstruction

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Patient with fever, rigor and dyspnea

Severe dyspnea with shock

Fall from the 2nd floor

History: dyspnea, weight loss, dehydration with poor immunity

History; too shy to take of his shirt in the pool!

What is the difference?

Differential diagnosis?

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Abdominal surgery before 2 days

Cardiac ICU