1. ACoRN © 2005 Pneumothorax Drainage

2. Nov 2007 ACoRN © 2005-07 Acute deterioration is commonAcute deterioration is common Deviation of apex may be detectable if large pneumothoraxDeviation of apex may be detectable if large pneumothorax Breath sounds may be unequalBreath sounds may be unequal Asymmetry of chest rareAsymmetry of chest rare Tracheal deviation cannot be clinically noted (the neck is too short)Tracheal deviation cannot be clinically noted (the neck is too short) Pneumothorax: Clinical signs

3. Nov 2007 ACoRN © 2005-07 Chest transillumination To attempt to detect a pneumothorax at the bedside while awaiting for a chest radiographTo attempt to detect a pneumothorax at the bedside while awaiting for a chest radiograph After ruling out mechanical causes such as equipment malfunction, obstructed airway or ETT, or displaced ETTAfter ruling out mechanical causes such as equipment malfunction, obstructed airway or ETT, or displaced ETT

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5. Nov 2007 ACoRN © 2005-07 Needle aspirationNeedle aspiration –Emergency only –Can be diagnostic if no X-ray immediately available –Not for permanent drainage Chest tube placementChest tube placement –Infrequently used skill –May be done more safely if chest has not been previously needled Pneumothorax drainage

6. Nov 2007 ACoRN © 2005-07 Needle aspiration

7. Nov 2007 ACoRN © 2005-07 Chest tube insertion

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9. Nov 2007 ACoRN © 2005-07 Before preparing your equipment, what should you consider?Before preparing your equipment, what should you consider? HINT (does the procedure hurt?)HINT (does the procedure hurt?)

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17. Nov 2007 ACoRN © 2005-07 Insertion of chest tube

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24. ACoRN © 2005 Chest Tube Drainage Systems

25. Nov 2007 ACoRN © 2005-07 Flutter valve

26. Nov 2007 ACoRN © 2005-07 Underwater drainage Collection chamber Suction pressure Underwater seal Patient end Wall suction

27. Nov 2007 ACoRN © 2005-07 Pleur-evac

28. Nov 2007 ACoRN © 2005-07 Vacuum regulators

29. Nov 2007 ACoRN © 2005-07 Questions?