✔️ Make a ~3 cm horizontal skin incision one rib space below. ✔️ Create soft tissue tunnel w/ curved clamp. ✔️With clamp closed, push/pop through intercostal muscles and pleural of rib above skin incision, spread open muscle/pleural ➡️ stay on top of rib to avoid injury to intercostal bundle.... ✔️ Finger sweep to confirm you have entered the pleural space & there are no adhesions. ✔️ Use finger + clamp to guide tube insertion (typically, apical + posterior), ensure all drainage holes are in chest. ✔️ Secure, connect to pleurovac, & obtain chest x-ray. Now, watch how to do it: More BehindTheKnife TRAUMA 📹 🧵 2/2show more

Chest tube insertion is a fundamental skill. Here, we review standard tube thoracostomy: ✔️ For traumatic hemo/pneumothorax, small bore chest tubes are non-inferior to large bore chest tubes ➡️28 Fr is the largest tube you need. ✔️ Insert at intersection of anterior axillary line & nipple/inframammary fold ➡️ ~5th intercostal space. ✔️When time allows, anesthetize the site of insertion, including the skin, subcutaneous tract, intercostal muscle, & periosteum. 🧵 1/2

If you don’t mind a suggestion: 1) I recommend an intercostal nerve block once the intercostals are exposed during in order to avoid procedural pain in patients; 2) I recommend spreading, not popping, through the intercostal muscles, which is more comfortable for awake pts.

Great recommendations!

great stuff