When to put in a chest drain on the basis of a CXR post trauma?
• Any post-traumatic pneumothorax. • Any post-traumatic subcutaneous emphysema • Haemothorax blunting the costophrenic angle. • The above are particularly important if a procedure is to be performed under general anaesthetic and positive pressure ventilation. 3. Positioning of formal chest drains. Once the situation has stabilised formal therapeutic drains should be inserted – preferably by a Thoracic Registrar. Blunt trocars may be necessary to achieve the ideal positions: • Antero-apical for air • Postero basal for blood. A ventillated patient will not be able to cough blood out through a single apical drain. There is likely to be more blood than you think lying posteriorly. Therefore a routine second posterobasal drain should be considered and the drains placed on suction. Similarly, a patient in pain will not be able to cough adequately and further drains and suction may be required. 4. What if a drain stops working? • The most frequent cause is that the drain is surrounded by clot
