William Deaton, D.O.
Metro Health Hospital
Grand Rapids, MI
<=
/div>
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Content-Location: file:///C:/907C5513/CardiothoracicProcedures_files/slide0002.htm
Content-Transfer-Encoding: quoted-printable
Content-Type: text/html; charset="us-ascii"
Cardiothoracic Procedures
Cardiothoracic Procedures
<=
span
class=3DBB style=3D'position:absolute;left:-4.43%;top:-.15em'>•Pericardiocentes=
is
<=
span
class=3DBB style=3D'position:absolute;left:-4.43%;top:-.15em'>•Chest Tube
<=
/span>
<=
span
class=3DBB style=3D'position:absolute;left:-4.43%;top:-.15em'>•Needle
Decompression
<=
span
class=3DBB style=3D'position:absolute;left:-4.43%;top:-.15em'>•Thoracotomy
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Content-Location: file:///C:/907C5513/CardiothoracicProcedures_files/slide0003.htm
Content-Transfer-Encoding: quoted-printable
Content-Type: text/html; charset="us-ascii"
Cardiothoracic Procedures
Pericardiocentesis
• Indications:
•
1. Diagnostic/Therape=
utic
during PEA arrest.
•
2. Cardiac Tamponade
(traumatic)
• ALL OTHER PATIENTS
(unless in severe hemodynamic instability) WOULD BENEFIT =
FROM FLUOROSCOPY
GUIDED PERICARDIOCENTESIS.
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Content-Transfer-Encoding: quoted-printable
Content-Type: text/html; charset="us-ascii"
Cardiothoracic Procedures
Pericardiocentesis
• Complications: Using fluoro or ultrasound =
is rare. Blind has a very high incidence o=
f =
ventricular
puncture.
• Rarely can cause sudden ventricular <=
/span>dilatation and
pulmonary edema.
------=_NextPart_01C797FE.3E8DB470
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Content-Transfer-Encoding: quoted-printable
Content-Type: text/html; charset="us-ascii"
Cardiothoracic Procedures
Pericardiocentesis
• Using a large sy=
ringe,
introduce a 18ga spinal needle 1cm inferior of the costal =
margin and to th=
e left
of the xiphoid at a 30 degree angle while aiming at the <=
/span>ispilateral nipp=
le.
• Advance the needle, while holding =
continual suctio=
n,
until blood or fluid is aspirated.
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Content-Transfer-Encoding: quoted-printable
Content-Type: text/html; charset="us-ascii"
Cardiothoracic Procedures
Pericardiocentesis
• If a large amoun=
t of
free flowing, bright red blood is obtained……
=
•Otherwise, can p=
lace a
pig tail catheter through the needle if the appropriate materials are
present. If not, have Cardiology place=
while
in the cath lab.
------=_NextPart_01C797FE.3E8DB470
Content-Location: file:///C:/907C5513/CardiothoracicProcedures_files/slide0018.htm
Content-Transfer-Encoding: quoted-printable
Content-Type: text/html; charset="us-ascii"
Cardiothoracic Procedures
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Content-Transfer-Encoding: quoted-printable
Content-Type: text/html; charset="us-ascii"
Cardiothoracic Procedures
Chest Tube
• Indications:
•
Removal of Air, Blood, or Pus in the =
pleural cavity.&=
#13;
• Traumatic pneumothorax, hemothorax=
, spontaneous
pneumothorax >20%, chest trauma without evidence of a pneumothorax but=
the
pt is undergoing positive pressure ventilation.
•
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Content-Location: file:///C:/907C5513/CardiothoracicProcedures_files/slide0008.htm
Content-Transfer-Encoding: quoted-printable
Content-Type: text/html; charset="us-ascii"
Cardiothoracic Procedures
Chest Tube
<=
span
class=3DBB style=3D'position:absolute;left:-4.43%;top:-.15em'>•Complications:&#=
13;
<=
span
class=3DBB style=3D'position:absolute;left:-4.43%;top:-.15em'>• 1.
Empyema
• 2.
Puncture a bleb causing a pleural fistula
• 3.
Liver/Heart/Stomach perforation
<=
span
class=3DBB style=3D'position:absolute;left:-4.43%;top:-.15em'>• 4.
Intraperitoneal placement
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Content-Transfer-Encoding: quoted-printable
Content-Type: text/html; charset="us-ascii"
Cardiothoracic Procedures
Chest Tube
• Po=
sition
the pt in a 30 degree angle head up if st=
able.
• Anesthesia with lidocaine DOWN TO THE PL=
EURA,
and appropriate sedation if needed.
• Apply Kelly to the tip of the chest tube prior to =
in=
cision.
=
• Incise along the rib axis through all layers of sk=
in
2cm-5cm depending on the size of the pt.
------=_NextPart_01C797FE.3E8DB470
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Content-Transfer-Encoding: quoted-printable
Content-Type: text/html; charset="us-ascii"
Cardiothoracic Procedures
Chest Tube
• Di=
ssect
bluntly with the Kelly clamp over the rib to=
avoid
the neurovascular bundle.
• Pu=
ncture
the pleura. Open the Kelly a=
nd
stretch the tissue while withdrawing the Kelly.
<=
/span>
• In=
sert
your finger into the track and feel for any ad=
hesions. Also make sure you are not agains=
t the
heart, liver, stomach…
• Pl=
ace
the tube into the track using the Kelly cl=
amp on
the tip, directing the tube posterior and
superior. Place approximatel=
y 12
cm OR until resistance is felt.
------=_NextPart_01C797FE.3E8DB470
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Content-Transfer-Encoding: quoted-printable
Content-Type: text/html; charset="us-ascii"
Cardiothoracic Procedures
Chest Tube
<=
span
class=3DBB style=3D'position:absolute;left:-4.43%;top:-.15em'>•Secure the tube =
with
suture.
•Place sterile dr=
essing
with Xeroform or Vaseline gauze and stretch tape.
=
<=
span
class=3DBB style=3D'position:absolute;left:-3.81%;top:-.15em'>•Place tube to 20=
cm
suction via pleuravac.
------=_NextPart_01C797FE.3E8DB470
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Content-Transfer-Encoding: quoted-printable
Content-Type: text/html; charset="us-ascii"
Cardiothoracic Procedures
Chest Tube
•
------=_NextPart_01C797FE.3E8DB470
Content-Location: file:///C:/907C5513/CardiothoracicProcedures_files/slide0020.htm
Content-Transfer-Encoding: quoted-printable
Content-Type: text/html; charset="us-ascii"
Cardiothoracic Procedures
------=_NextPart_01C797FE.3E8DB470
Content-Location: file:///C:/907C5513/CardiothoracicProcedures_files/slide0012.htm
Content-Transfer-Encoding: quoted-printable
Content-Type: text/html; charset="us-ascii"
Cardiothoracic Procedures
Needle Decompression
<=
span
class=3DBB style=3D'position:absolute;left:-4.43%;top:-.15em'>•Indications:
=
;
<=
span
class=3DBB style=3D'position:absolute;left:-4.43%;top:-.15em'>• Tension pneumothorax
• Severe pneumothorax while in the =
field or have a chest =
tube
unavailable
<=
span
class=3DBB style=3D'position:absolute;left:-4.43%;top:-.15em'>• Chest trauma and cardiac arrest&#=
13;
• Positive pressure ventilation and
cardiac arrest
------=_NextPart_01C797FE.3E8DB470
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Content-Transfer-Encoding: quoted-printable
Content-Type: text/html; charset="us-ascii"
Cardiothoracic Procedures
Needle Decompression
<=
span
class=3DBB style=3D'position:absolute;left:-4.43%;top:-.15em'>•Complications=
3;
<=
span
class=3DBB style=3D'position:absolute;left:-4.43%;top:-.15em'>• Tension pneumothorax
<=
span
class=3DBB style=3D'position:absolute;left:-4.43%;top:-.15em'>• Pneumothorax
<=
span
class=3DBB style=3D'position:absolute;left:-4.43%;top:-.15em'>• Empyema
------=_NextPart_01C797FE.3E8DB470
Content-Location: file:///C:/907C5513/CardiothoracicProcedures_files/slide0014.htm
Content-Transfer-Encoding: quoted-printable
Content-Type: text/html; charset="us-ascii"
Cardiothoracic Procedures
Needle Decompression
• Using a large (1=
4-16
ga) angiocath, puncture the skin in the second intercostal =
=
space at the
midclavicular line.
<=
span
class=3DBB style=3D'position:absolute;left:-4.43%;top:-.15em'>•Place chest tube=
.
Cardiothoracic Procedures
Thoracotomy
• Indications:
•
Penetrating chest trauma with RECENT =
loss of vial
signs.
• Manage cardiac tamponade that can not be controlled wi=
th a
needle.
• To cross clamp the aorta to control <=
/span>=
intraabdominal
bleeding.
• To perform cardiac massage.
•
Cardiothoracic Procedures
Thoracotomy
• With the patient intubated, make a single large incision i=
n the
4 th intercostal space =
from the sternum=
to
the posterior axillary line.
•
Using Mayo scissors, cut the intercostal muscles using ca=
re not
to damage the lung tissue.
• Insert rib spreaders and crank open. <=
/span>
Cardiothoracic Procedures
Thoracotomy
Cardiothoracic Procedures
------=_NextPart_01C797FE.3E8DB470
Content-Location: file:///C:/907C5513/CardiothoracicProcedures_files/slide0017.htm
Content-Transfer-Encoding: quoted-printable
Content-Type: text/html; charset="us-ascii"
Cardiothoracic Procedures
Thoracotomy
• Mo=
ve the
lung manually and evacuate any clots to vi=
sualize
the pericardium.
• Gr=
asp
the pericardium with Allis clamps or hemostats <=
span
style=3D'font-family:Tahoma;mso-ascii-font-family:Tahoma;font-size:75%'>and
retract. Using scissors inci=
se the
pericardium near the clamps.
• Re=
move
and clots in the pericardium, or repair the ca=
rdiac
tissue if needed.
• To=
cross
clamp the aorta, dissect to the aorta bluntly, =
and
using a aortic occlusion clamp (soft clamp).
• Ca=
ll
cardiothoracic/vascular surgery.
Cardiothoracic Procedures
THE END
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/*********************************************
Navigation button implementation
There are 2 types of buttons: ImgBtn, TxtBtn
implemented as function objects. They share
a similiar interface so the event handlers
can call SetActive, for example, on a button=20
object without needing to know exactly=20
what type of button it is.
**********************************************/
//----------------------------------
function ImgBtn( oId,bId,w,action )
//----------------------------------
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t.SetActive =3D _IBSetA
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obj=3Dthis.ChgState( gFaceClr,gFaceClr,1 )
obj.style.posTop=3D0=20
}
}
function _IBSetP()
{
if( this.mIsOn ) {
obj=3Dthis.ChgState( gShadowClr,gHiliteClr,2 )
obj.style.posLeft+=3D1; obj.style.posTop+=3D1
}
}
function _IBSetD()
{ =20
obj=3Dthis.ChgState( gFaceClr,gFaceClr,0 )
obj.style.posTop=3D0=20
}
function _IBSetE( state )
{
var t=3Dthis
GetObj( t.mBorderId ).style.visibility=3D"visible"
if( state !=3D t.mIsOn ) {
t.mIsOn=3Dstate
if( state )
t.SetInactive()
else
t.SetDisabled()
}
}
function _IBP()
{
var t=3Dthis
if( t.mIsOn ) {
if( t.UserAction !=3D null )
t.UserAction()
if( t.ChangeIcon ) {
obj=3DGetObj(t.mObjId)
if( t.ChangeIcon() )
obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-4)*t.mWidth
else
obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-0)*t.mWidth
}
t.SetActive()
} =20
}
function _IBUI( clr1,clr2,nextState )
{
var t=3Dthis
SetBorder( GetObj( t.mBorderId ),clr1,clr2 )
obj=3DGetObj( t.mObjId )
obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-nextState)*t.mWidth-obj=
.style.posTop
t.mCurState=3DnextState
return obj
}
//-----------------------------------------
function TxtBtn( oId,oeId,action,chkState )
//-----------------------------------------
{
var t=3Dthis
t.Perform =3D _TBP
t.SetActive =3D _TBSetA
t.SetInactive=3D _TBSetI
t.SetPressed =3D _TBSetP
t.SetDisabled=3D _TBSetD
t.SetEnabled =3D _TBSetE
t.GetState =3D chkState
t.UserAction =3D action
t.ChgState =3D _TBUI
t.mObjId =3D oId
t.m_elementsId=3D oeId
t.mIsOn =3D 1
}
function _TBSetA()
{
var t=3Dthis
if( t.mIsOn && !t.GetState() )
t.ChgState( gHiliteClr,gShadowClr,0,0 )
}
function _TBSetI()
{
var t=3Dthis
if( t.mIsOn && !t.GetState() )
t.ChgState( gFaceClr,gFaceClr,0,0 )
}
function _TBSetP()
{
if( this.mIsOn )
this.ChgState( gShadowClr,gHiliteClr,1,1 )
}
function _TBSetD()
{ =20
this.ChgState( gFaceClr,gFaceClr,0,0 )
this.mIsOn =3D 0
}
function _TBSetE()
{
var t=3Dthis
if( !t.GetState() )
t.ChgState( gFaceClr,gFaceClr,0,0 )
else
t.ChgState( gShadowClr,gHiliteClr,1,1 )
t.mIsOn =3D 1
}
function _TBP()
{
var t=3Dthis
if( t.mIsOn ) {=20
if( t.UserAction !=3D null )
t.UserAction()
if( !t.GetState )
return
if( t.GetState() )
t.SetPressed()
else
t.SetActive()
} =20
}
function _TBUI( clr1,clr2,lOffset,tOffset )
{
SetBorder( GetObj( this.mObjId ),clr1,clr2 )
Offset( GetObj( this.m_elementsId ),lOffset,tOffset )
}
function Offset( obj, top, left ){ obj.style.top=3Dtop; obj.style.left=3Dle=
ft }
function SetBorder( obj, upperLeft, lowerRight )
{
s=3Dobj.style;
s.borderStyle =3D "solid"
s.borderWidth =3D 1=20
s.borderLeftColor =3D s.borderTopColor =3D upperLeft
s.borderBottomColor=3D s.borderRightColor =3D lowerRight
}
function GetBtnObj(){ return gBtnArr[window.event.srcElement.id] }
function BtnOnOver(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetActive() }
function BtnOnDown(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetPressed() }
function BtnOnOut(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetInactive() }
function BtnOnUp()
{
b=3DGetBtnObj()
if( b !=3D null )
b.Perform()
else
Upd()
}
function GetNtsState(){ return parent.gNtsOpen }
function GetOtlState(){ return parent.gOtlOpen }
function GetOtlTxtState(){ return parent.gOtlTxtExp }
function NtsBtnSetFlag( fVal )
{
s=3Ddocument.all.item( this.m_flagId ).style
s.display=3D"none"
if( fVal )
s.display=3D""
else
s.display=3D"none"
}
function _BSetA_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S=
etActive() }
function _BSetI_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S=
etInactive() }
function _BSetP_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S=
etPressed() }
function _BSetA_BorderImg()
{=20
b =3D gBtnArr[this.mBorderId]=20
if( b !=3D null && this.mIsOn && !b.GetState() ) {
obj=3Dthis.ChgState( gHiliteClr,gShadowClr,2 )
obj.style.posTop=3D0
}
}
function _BSetI_BorderImg()
{=20
b =3D gBtnArr[this.mBorderId]
if( b !=3D null && this.mIsOn && !b.GetState() ) {
obj=3Dthis.ChgState( gFaceClr,gFaceClr,1 )
obj.style.posTop=3D0
}
}
var gHiliteClr=3D"THREEDHIGHLIGHT",gShadowClr=3D"THREEDSHADOW",gFaceClr=3D"=
THREEDFACE"
var gBtnArr =3D new Array()
gBtnArr["nb_otl"] =3D new TxtBtn( "nb_otl","nb_otlElem",parent.ToggleOtlPan=
e,GetOtlState )
gBtnArr["nb_otlElem"] =3D new TxtBtn( "nb_otl","nb_otlElem",parent.ToggleOt=
lPane,GetOtlState )
gBtnArr["nb_nts"] =3D new ImgBtn( "nb_nts","nb_ntsBorder",10,parent.ToggleN=
tsPane )
gBtnArr["nb_nts"].SetActive =3D _BSetA_BorderImg;
gBtnArr["nb_nts"].SetInactive =3D _BSetI_BorderImg;
gBtnArr["nb_ntsBorder"] =3D new TxtBtn( "nb_ntsBorder","nb_ntsElem",parent.=
ToggleNtsPane,GetNtsState )
gBtnArr["nb_ntsElem"] =3D new TxtBtn( "nb_ntsBorder","nb_ntsElem",parent.To=
ggleNtsPane,GetNtsState )
gBtnArr["nb_prevBorder"] =3D gBtnArr["nb_prev"]=3D new ImgBtn( "nb_prev","n=
b_prevBorder",30,parent.GoToPrevSld )
gBtnArr["nb_nextBorder"] =3D gBtnArr["nb_next"]=3D new ImgBtn( "nb_next","n=
b_nextBorder",30,parent.GoToNextSld )
gBtnArr["nb_sldshw"]=3D new ImgBtn( "nb_sldshw","nb_sldshwBorder",18,parent=
.FullScreen )
gBtnArr["nb_sldshwBorder"] =3D new TxtBtn( "nb_sldshw","nb_sldshwBorder",pa=
rent.FullScreen,null )
gBtnArr["nb_sldshwBorder"].SetActive =3D _BSetA_Border;
gBtnArr["nb_sldshwBorder"].SetInactive =3D _BSetI_Border;
gBtnArr["nb_sldshwText"] =3D new TxtBtn( "nb_sldshw","nb_sldshwText",parent=
.FullScreen,null )
gBtnArr["nb_sldshwText"].SetActive =3D _BSetA_Border;
gBtnArr["nb_sldshwText"].SetInactive =3D _BSetI_Border;
gBtnArr["nb_voice"] =3D gBtnArr["nb_voiceBorder"] =3D new ImgBtn( "nb_voice=
","nb_voiceBorder",18,parent.ToggleVNarration )
gBtnArr["nb_otlTxtBorder"] =3D gBtnArr["nb_otlTxt"]=3D new ImgBtn( "nb_otlT=
xt","nb_otlTxtBorder",23,parent.ToggleOtlText )
gBtnArr["nb_ntsBorder"].m_flagId=3D "nb_nts"
gBtnArr["nb_ntsBorder"].SetFlag =3D NtsBtnSetFlag
gBtnArr["nb_otlTxt"].ChangeIcon=3D GetOtlTxtState
/*********************************************
Context menu implementation
_CM() is the function that's hooked up to
the oncontextmenu event. Once we're asked to
show the menu, we first build it by creating
DIVs on-the-fly. Then we position it=20
within the screen area so it doesn't get
clipped.
Creating the DIVs using createElement() means
we don't have to write out any extra HTML
into the slide HTML files.
**********************************************/
var sNext=3D"Next",sPrev=3D"Previous",sEnd=3D"End Show",sFont=3D"Arial",sAr=
row=3D"Arrow",sFreeform=3D"Freeform",sRect=3D"Rectangle",sOval=3D"Oval"
function ShowMenu()
{
BuildMenu();
var doc=3DPPTSld.document.body,x=3DPPTSld.event.clientX+doc.scrollLeft,y=
=3DPPTSld.event.clientY+doc.scrollTop
m =3D PPTSld.document.all.item("ctxtmenu")
m.style.pixelLeft=3Dx
if( (x+m.scrollWidth > doc.clientWidth)&&(x-m.scrollWidth > 0) )
m.style.pixelLeft=3Dx-m.scrollWidth
m.style.pixelTop=3Dy
if( (y+m.scrollHeight > doc.clientHeight)&&(y-m.scrollHeight > 0) )
m.style.pixelTop=3Dy-m.scrollHeight
m.style.display=3D""
}
function _CM()
{
if( !parent.IsFullScrMode() ) return;
if(!PPTSld.event.ctrlKey) {
ShowMenu()
return false
} else
HideMenu()
}
function BuildMenu()
{
if( PPTSld.document.all.item("ctxtmenu") ) return
var mObj=3DCreateItem( PPTSld.document.body )
mObj.id=3D"ctxtmenu"
mObj.style.visibility=3D"hidden"
var s=3DmObj.style
s.position=3D"absolute"
s.cursor=3D"default"
s.width=3D"120px"
SetCMBorder(mObj,"menu","black")
var iObj=3DCreateItem( mObj )
SetCMBorder( iObj, "threedhighlight","threedshadow" )
iObj.style.padding=3D2
CreateMenuItem( iObj,sNext,M_GoNextSld,M_True )
CreateMenuItem( iObj,sPrev,M_GoPrevSld,M_HasPrevSld )
=09
CreateSeparator( iObj )
CreateMenuItem( iObj,sEnd,M_End,M_True )
mObj.style.visibility=3D"visible"
}
function Cancel() { window.event.cancelBubble=3Dtrue; window.event.returnVa=
lue=3Dfalse }
function Highlight() { ChangeClr("activecaption","threedhighlight") }
function Deselect() { ChangeClr("threedface","menutext") }
function Perform()
{
e=3DPPTSld.event.srcElement
if( e.type=3D=3D"menuitem" && e.IsActive() )
e.Action()
else
PPTSld.event.cancelBubble=3Dtrue
}
function ChangeClr( bg,clr )
{
e=3DPPTSld.event.srcElement
if( e.type=3D=3D"menuitem" && e.IsActive() ) {
e.style.backgroundColor=3Dbg
e.style.color=3Dclr
}
}
function M_HasPrevSld() { return( parent.HasPrevSld() ) }
function M_GoNextSld() { if( gIsEndShow ) M_End(); else GoToNextSld() }
function M_GoPrevSld() { if( gIsEndShow ) { gIsEndShow=3D0; history.back();=
PPTSld.event.cancelBubble=3Dtrue; } else GoToPrevSld() }
function M_True() { return true }
function M_End() { window.close( self ) }
function CreateMenuItem( node,text,action,eval )
{
var e=3DCreateItem( node )
e.type=3D"menuitem"
e.Action=3Daction
e.IsActive=3Deval
e.innerHTML=3Dtext
if( !e.IsActive() )
e.style.color=3D"threedshadow"
e.onclick=3DPerform
e.onmouseover=3DHighlight
e.onmouseout=3DDeselect
s=3De.style;
s.fontFamily=3DsFont
s.fontSize=3D"9pt"
s.paddingLeft=3D2
}
function CreateSeparator( node )
{
var sObj=3DCreateItem( node )
SetCMBorder(sObj,"menu","menu")
var s=3DsObj.style
s.borderTopColor=3D"threedshadow"
s.borderBottomColor=3D"threedhighlight"
s.height=3D1
s.fontSize=3D"0px"
}
function CreateItem( node )
{
var elem=3DPPTSld.document.createElement("DIV")
node.insertBefore( elem )
return elem
}
function SetCMBorder( o,ltClr,rbClr )
{
var s=3Do.style
s.backgroundColor=3D"menu"
s.borderStyle=3D"solid"
s.borderWidth=3D1
s.borderColor=3DltClr+" "+rbClr+" "+rbClr+" "+ltClr
}
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Cardiothoracic Procedures
------=_NextPart_01C797FE.3E8DB470
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No=
tes
1
William Deaton, D.O.
Metro Health Hospital
Grand Rapids, MI
2
Pericardiocentesis
Chest Tube
Needle Decompression
Thoracotomy
3
Indications:
1. Diagnostic/Therapeutic duri=
ng PEA
arrest. 2. Cardiac Tamponade (traumati=
c)ALL OTHER PATIENTS (unless in severe hemodynamic instability) WOULD
BENEFIT FROM FLUOROSCOPY GUIDED PERICARDIOCENTESIS.
4
Complications: Using f=
luoro
or ultrasound is rare. Blind
has a very high incidence of ventricular puncture.
Rarely can cause sudden ventricular dilatation and pulmonary edema.<=
/li>
5
Using a large syringe, introduce a 18ga spinal needle 1cm inferior of
the costal margin and to the left of the xiphoid at a 30 degree angle
while aiming at the ispilateral nipple.
Advance the needle, while holding continual suction, until blood or
fluid is aspirated.
6
If a large amount of free flowing, bright red blood is
obtained……
Otherwise, can place a pig tail catheter through the needle if the
appropriate materials are present.&=
nbsp;
If not, have Cardiology place while in the cath lab.
7
8
Indications:
Removal of Air, Blood=
, or
Pus in the pleural cavity. Traumatic pneumothorax,
hemothorax, spontaneous pneumothorax >20%, chest trauma without
evidence of a pneumothorax but the pt is undergoing positive pressure
ventilation.
9
Complications:
1. Empyema 2. Puncture a bleb causing a p=
leural
fistula 3. Liver/Heart/Stomach perfora=
tion 4. Intraperitoneal placement
10
Position the pt in a 30 degree angle head up if stable.
Anesthesia with lidocaine DOWN TO THE PLEURA, and appropriate sedati=
on
if needed.
Apply Kelly to the tip of the chest tube prior to incision.
Incise along the rib axis through all layers of skin 2cm-5cm dependi=
ng
on the size of the pt.
11
Dissect bluntly with the Kelly clamp over the rib to avoid the
neurovascular bundle.
Puncture the pleura. O=
pen
the Kelly and stretch the tissue while withdrawing the Kelly.
Insert your finger into the track and feel for any adhesions. Also make sure you are not
against the heart, liver, stomach…
Place the tube into the track using the Kelly clamp on the tip,
directing the tube posterior and superior. Place approximately 12 cm OR
until resistance is felt.
12
Secure the tube with suture.
Place sterile dressing with Xeroform or Vaseline gauze and stretch t=
ape.
Place tube to 20cm suction via pleuravac.
13
14
15
Indications:
Tension pneumothorax<=
/li>
Severe pneumothorax w=
hile
in the field or have a chest tube unavailable Chest trauma and card=
iac
arrest Positive pressure
ventilation and cardiac arrest
16
Complications
Tension pneumothorax<=
/li>
Pneumothorax Empyema
17
Using a large (14-16 ga) angiocath, puncture the skin in the second
intercostal space at the midclavicular line.
Place chest tube.
18
Indications:
Penetrating chest tra=
uma
with RECENT loss of vial signs.Manage cardiac tamponade that can not be controlled with a needle.
To cross clamp the aorta to control intraabdominal bleeding.
To perform cardiac massage.
19
With the patient intubated, make a single large incision in the 4th
intercostal space from the sternum to the posterior axillary line.
Using Mayo scissors, =
cut
the intercostal muscles using care not to damage the lung tissue.
Insert rib spreaders and crank open.
20
21
22
Move the lung manually and evacuate any clots to visualize the
pericardium.
Grasp the pericardium with Allis clamps or hemostats and retract. Using scissors incise the
pericardium near the clamps.
Remove and clots in the pericardium, or repair the cardiac tissue if=
needed.
To cross clamp the aorta, dissect to the aorta bluntly, and using a
aortic occlusion clamp (soft clamp).
Call cardiothoracic/vascular surgery.
23
=
=
=
=
=
=
=
=
=
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=
=
=
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=
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=
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No=
tes![](3D"buttons.gif")
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