Chest Tube Tips
I’ve written a lot about chest tubes, but there’s actually a lot to know. And a fair amount of misinformation as well. Here’s some info you need to be familiar with:
Chest trauma generally means there is some blood in the chest. This has some bearing on which size chest tube you choose. Never assume that there is only pneumothorax based on the chest xray. Clot will plug up small tubes.
Chest tubes for trauma only come in two sizes: big (36Fr) and bigger (40Fr). Only these large sizes have a chance in evacuating most of the clot from the pleural space. The only time you should consider a smaller tube, or a pigtail type catheter, is if you know for a fact that there is no blood in the chest. The only way to tell this is with chest CT, which you should not be getting for diagnosis of ordinary chest trauma.
When inserting the tube, you have no control of the location the tube goes once you release the instrument used to place it. Some people believe they can direct a tube anteriorly, posteriorly, or anywhere they want. They can’t, and it’s not important (see next tip).
Specific tube placement is not important, as long as it goes in the pleural space. Some believe that posterior placement is best for hemothorax, and anterior placement for pneumothorax. It doesn’t really matter because the laws of physics make sure that everything gets sucked out of the chest regardless of position except for things too big to fit in the tube (e.g. the lung).
Tunneling the tube tract over a rib is not necessary in most people. In general, we have enough fat on our chest to ensure that the tract will close up immediately when the tube is pulled. A nicely placed dressing is your insurance policy.
Adhere to an organized tube management protocol to reduce complications and the time the tube is in the chest.
And finally, amaze your friends! The French system used to size chest tubes is the diameter of the tube in millimeters times three. So a 40Fr chest tube has a diameter of 13.3mm.
Related posts:
Dry seal chest tube systems
Troubleshooting air leaks in chest tubes
Managing chest tube air leaks



Who needs traffic lights? Not the drivers in Ethiopia - Video

This made me so uncomfortable.

I never realized I had an anxiety problem until I stared at these GIFs…

Do you have a few minutes to stay and talk to me? It doesn’t matter what you talk about. I just get lonely siting in this room all day.

Newly diagnosed cancer patient with very poor prognosis in the ICU, to me on my morning rounds

(via wayfaringmd)



In Phoenix , Arizona , a 26-year-old mother stared down

at her 6 year old son, who was dying of leukemia.Although her heart was filled with sadness,she also had a strong feeling of determinationLike any mother, she wanted her son to grow up &fulfill all his dreams. Now that was no longer possible..The leukemia would see to that. But she stillwanted her son’s dream to come true.She took her son’ s hand and asked,‘Billy, did you ever think about what you wantedto be once you grew up?Did you ever dream and wish about what you woulddo with your life?’Mommy, ‘I always wanted to be a firemanwhen I grew up.’Mom smiled back and said, ‘Let’s see if we canmake your wish come true.’Later that day she went to her local fireDepartment in Phoenix , Arizona , where she metFireman Bob, who had! a heart as big as Phoenix She explained her son’s final wish andasked if it might be possible to give her 6 year-old
son a ride around the block on a fire engineFireman Bob said, ‘Look, we can dobetter than that. If you’ll have your son ready at7 o’clock Wednesday morning, we’ll makehim an honorary Fireman for the whole day.He can come down to the fire station, eat with us,go out on all the fire calls, the whole nine yards! And if you’ll give us his sizes, we’ll get a real fire uniformfor him, with a real fire hat - not a toy — one-with the emblem
of the Phoenix Fire Department on it, a yellow slicker like
we wear, and rubber boots.’‘They’re all manufactured right here in Phoenix ,so we can get them fast.’ Three days later Fireman Bob picked up Billy,dressed him in his uniform and escorted him from his hospital
bed to the waiting hook and ladder truck.Billy got to sit on the back of the truckand help steer it back to the fire station.He was in heaven.There were three fire calls in Phoenix that dayand Billy got to go out on all three calls.He rode in the different fire engines,the Paramedic’s’ van,and even the fire chief’s car.He was also videotaped for thelocal news program.Having his dream come true,with all the love and attention that was lavished upon him,
so deeply touched Billy, that he lived three months longer
than any doctor thought possible.One night all of his vital signs began todrop dramatically and the head nurse, who believedin the hospice concept - that no one should die alone,
began to call the family members to the hospital.Then she remembered the day Billy had spentas a Fireman, so she called the Fire Chief andasked if it would be possible to send a firemanin uniform to the hospital to be with Billy as he
made his transition.The chief replied, “We can do better than that.We’ll be there in five minutes.. Will you please do me a favor?When you hear the sirens screaming and see thelights flashing, will you announce over thePA system at the hospital that there is not a fire?”‘It’s the department coming to see one of its finest members
one more time. And will you open the window to his room?’About five minutes later a hook and ladder truck arrived
at the hospital and extended its ladder up to Billy’s third floor
open window 16 fire-fighters climbed up the ladder into Billy’s
room.With his mother’s permission, they hugged him and held
him and told him how much they LOVED him.

With his dying breath, Billy looked up at the fire chief and said,‘Chief, am I really a fireman now?’‘Billy, you are, and The Head Chief, Jesus,
is holding your hand,’ the chief said.With those words, Billy smiled and said,‘I know, He’s been holding my hand all day, and the angels have been singing..’He closed his eyes one last time.

Fucking crying mess at work, THANKS GUYS.



(Source: sandandglass)

When I see food..



I definitely never used MHIO but now I’m considering it

Prolapsing My Colon? Really lol? 
Sex BBQ sounds interesting.

When I constantly run from room to room the entire shift.



The nicest thing a patient can say to you





Whats your take on this fellow nurses?

I’m fine with it. Doesn’t bother me. I always violate the “visiting hours” policy- I really don’t care if someone wants to come see you after 8. I don’t care if you want your whole family in the room with you. I’ve done gymnastics stepping over a family of 8 with the 5 non-sick children sleeping on the floor. I honestly don’t even care if your boyfriend wants to sleep in the bed with you either, but I know many nurses who draw the line there. I’m used to parents sleeping in bed with their kids, so it’s not hard for me to extend the line a little, as long as I can still take care of my patient. What makes you comfortable and happy is up to you, as long as it’s not hurting anybody. 
I understand, however, that an ED or ICU environment is a lot different. Most of my patients are very stable and it’s not a big deal (or it shouldn’t be- but I’m not one to follow the rules just because they’re rules). 
THE ONLY THING I DO NOT ALLOW: co-sleeping with infants. Not gonna happen. You have to sign a damn waiver and I will very carefully explain the risks and dangers to you. I have taken a baby from a mom and put him back in the bassinet when she refused to sign the waiver. There will be no SIDS-ing on my watch. 

Sure you can stay, but remember that I can tell if you’re having sex just by looking at your EKG monitor.Vtach my ass.






does anyone else accidentally stare at a boys penis when hes wearing pants

me but it’s never an accident


yep, I’m just like, how can you hide a penis there? like where does it go?

it’s not even in a sexual way, i’m just like, how does it fit in there? is it uncomfortable?

Yes, it’s uncomfortable. The balls are the worst part. If the pants are even slightly uncomfortable, I find myself doing engaging in impromptu displays of the stanky leg dance.



Ectopia cordis

It’s a congenital malformation in which the heart is abnormally located either partially or totally outside of the thorax. The ectopic heart can be found along a spectrum of anatomical locations, including the neck, chest, or abdomen. In most cases, the heart protrudes outside the chest through a split sternum