Dr.KAMRAN YOUSAF FCPS,MRCS GEN SURGEON,MEEQAT GEN HOSPITAL MADINA MUNAWWARA

1. KAMRAN YOUSAF
FCPS,MRCS
GEN SURGEON,MEEQAT GEN HOSPITAL
MADINA MUNAWWARA

2.  CHEST/INTERCOSTAL INTUBATION OR
TUBE THORACOSTOMY IS A LIFE SAVING
PROCEDURE WHEREBY A PLASTIC TUBE IS
INSERTED INTO THE PLEURAL CAVITY TO
DRAIN FLUID,AIR OR BOTH
 IT CAN BE PERFORMED AT THE BEDSIDE
 EVERY SURGICAL/ER RESIDENT IS
EXPECTED TO PERFORM IT AND SHOULD
BE TRAINED SO

3.  TRAUMATIC
 AND NON TRAUMATIC
 HAEMOTHORAX
 PNEUMOTHORAX
 PYOTHORAX/EMPYEMA THORAX
 CHYLOTHORAX
 PST OPERATIVE THORACOTOMY

7.  LUNG ADHERENT TO THE CHEST WALL
 COAGULOPATHY

8.  CORRECT PROCEDURE,CORRECT PATIENT
AND CORRECT SIDE
 WRITTEN INFORMED COSENT
 PREPARE THE EQUIPMENT
 STERILE ENVIRONMENT
 DISPLAY THE X-RAYS IN THE
ILLUMINATOR BOX
 POSITION OF THE PATIENT

11.  4TH/5TH INTERCOSTAL SPACE
 LATERAL BORDER OF PEC MAJ
 ANT BORDER OF LAT DOR
 HORIZONTAL LINE FROM NIPPLE
 APEX JUST BELOW AXILLA

12.  STERILE GLOVES/GOWN/DRAPES/BETADINE
 CHEST TUBE AND THE DRAINAGE SYSTEM
 SYRINGE
 LOCAL ANAESTHESIA
 SCALPEL
 ARTERY FORCEPS
 THUMB FORCEPS
 SCISSORS
 NEEDLE HOLDER
 SUTURE MATERIALS
 GAUZE/DRESSING MATERIALS

15.  THREE TYPES
 THORACOTOMY CHEST TUBE
 TROCAR CHEST TUBE
 MALECOT CATHETER
 SIZE
 24-32 F FOR MOST ADULTS
 36-40 F FOR HEAVILY BUILT

21.  OBSERVE PATIET’S
 BREATHING PATTERN
 OXYGEN SATURATION
 VITAL SIGNS
 ANXIETY
 ANALGESIA BEFORE THE PROCEDURE
 READY UNDERWATERSEAL

22.  MONITOR VITALS,,,30 MIN/2 H,THEN
HOURLY FOR 4 HOURS
 MONITOR HIS RESPIRATION
 RATE,RYTHEM AD PATTERN OF BREATHING
 MONITOR OXYGEN SATURATION
 POST INTUBATION CXR
 MONITOR THE TUBES/DRESSING
 PLACEA PILLOW BETWEEN THE PATIENT
AND THE TUBE
 AVOID COILS OF TUBE,NEVER TO RISE IT
ABOVE THE CHEST LEVEL

23.  IF BLOCKED,ENCOURAGE COUGHING AND
MILK THE TUBE
 NO UNNECESSARY CLAMPING
 EXCEPT DURING TRANSFER/CHANGE
 DRAIN OUTPUT RCORD
 CHANGE BOTTLE EVERY 24/48 HOURS OR
WHEN FULL
 ENCOURAGE AMBULATION AND
BREATHING EXCERCISES AND POSITIONAL
CHANGES
 GOOD ANALGESIA AND HYGIENE

24.  INJURY TO LUNGS
 INJURY TO LIVER/SPLEEN
 WRONG PLACEMENT
 NEUROVASCULAR BUNDLE
 INFECTION

25.  WHEN ITS NO LONGER REQUIRD
 THE INDICATION DOES’NT EXIST
 FLUID/AIR HAVE BEED DRAINED,LUNG
HAS EXPANDED,BREATHING IS
NORMAL,SATURATION IS GOOD AND THE
CHEST X-RAY IS NORMAL
 CLAMP FOR 2 HOURS,NO ISSUES
 REMOVE

26.  DURING THE PROCEDURE
 BLEEDING,SATURATION DROP,WRONG
INTUBATION
 POST PROCEDURE
 TUBE DISLODGEMENT,BLOCKAGE ETC

27.  PRE-OP,,,ENSURE,CONSENT,RIGHT,RIGHT
AND RIGHT
 ENSURE AEPTIC ENVIRONMENT,EQUIPMENT
 ENSURE IV LINE/CXR IN ILUMINATOR
 DURING PROCEDURE,MONITORING,READY
UNDERWATERSEAL,IV FLUIDS,O2
SUPPLY,SPARE INSTRUMENTS,TUBES
 POST PROCEDURE,MONITOR THE
DRESSING,TUBES,DRAIN,FLUID
LEVEL,BUBBLING,VITALS,O2 SAT,CXR

28.  LIFE SAVING PROCEDURE
 AIR,FLUID,BOTH
 ASEPTIC ENVIRONENT,PROPER
EQUIPMENT,RIGHT,RIGHT,RIGHT
 ANTICIPATE AND PREPARE FOR
UNEXPECTED COMPLICATIONS
 MONITOR DURING AND AFTER THE
PROCEDURE
 REMOVE WHEN NOT NEEDED

29. FOUNDER OF MODERN NURSING