Hemothorax: New and Interesting Treatments

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Kenneth D. -

That's fantastic. For years I've been stuck on that idea of small tubes for air and big (huge) tubes for fluid. I have asked surgeons occasionally about this and got sneered at. It makes perfect sense. What is in there that needs such a big tube? We actually draw blood through a 20 gauge needle! It's not like we're sucking out lung fragments or anything like that.
One of the best segments I've heard for a while.

David W. -

My question /. concern with a small tube size is what happens once you start getting clots which would obstruct the release of the fluid wanting to be vacated (thus the aim for a larger tube size to allow vacation of clot(s) as well as the blood / fluid). Just a thought from outside the circle / box.

Mel H. -

Much the same as for a large tube, remove and replace, irrigate, ignore and blame...

Kevin M. -

Does mechanism make a difference, ie, blunt=sterile, vs penetrating, all get tubes?? We use small tubes placed with Seldinger technique for spontaneous PNX, interesting that these may be used for empyema or small PNX.

Mel H. -

I think with multiple broken ribs, a big contusion and the likelihood of a large air leak, a real tube will probably be needed. But simply by asking the question "do I really need the big tube" I think we will find lots of times the answer is no. If the little tube fails, you can always go back and put in the big mama. For me, I would like you to try the little mama first!

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Episode 134 Full episode audio for MD edition 239:14 min - 99 MB - M4AEM:RAP November 2012 Written Summary 2 MB - PDF