Thoracic Trauma Overview


Chest Tube Size
Condition Tube Size
Tension Pneumothorax
 
24-28 Fr
OR Needle thoracostomy
Open Pneumothorax 28 Fr
Hemothorax 32 Fr
Flail Chest 36 Fr (At least)
Malignant Effusion 8-18 Fr
Parapneumonic effusion Most Pt: 10-14 Fr (small cath for pt comfort)
Viscous fluid or loculated on CT: 16-24 Fr
Empyema Stage 1 Empyema: 28 Fr or larger
Stage 2 Empyema: chest tube warranted but may fail --> Thoracic surgery consult
Stage 3 Empyema: Chest tube drainage will almost assuredly result in treatment failure.


Background

Pathophysiology

Diagnostics

General Treatment

  1. Prehospital
  2. ED arrival
  3. ATLS Primary survey
  4. Secondary survey
  5. Fluid resuscitation
  6. FAST scan or ultrasound if available
  7. Treat pain:
  8. Tetanus prophylaxis
  9. Surgical treatment

Disposition

  1. Hospitalize all patients