>BTW, what does the list think about the practice of aspirating small
>spontaneous pneumothoraces ? This practice/fad seems endemic amongst
>physicians in Hong Kong but I think it's unnecessary in most cases. I've
>treated dozens of these conservatively with careful advice to the patient on
>activity and when to seek further help, and they have all resolved by 1-2
>weeks. Anyone had their fingers burned by doing similar ?
>
>Rob Cocks
Most of these are seen and discharged in A&E, but a few get as far as the
physicians. I tend to sit on them for a few hours to make sure they are
clinically stable, then discharge them with strict advice to return
immediately if dyspnea worsens. For bigger pneumothoraces, <50% I would
try apsiration first, then consider chest tube insertion depending on
clinical condition. >50% pneumothorax mandates tube placement.
Interestingly, in the last hospital I worked in tubes were supplied without
trochars, in line with the teaching that one should put them in with
forceps. This seems to be driven by the surgeons rather than the chest
physicians, and I suspect it's due to ATLS teaching. Does anyone on the
list have any opinions as to whether using a plastic introducer is
acceptable? These are made by Portex, and go in through the proximal drain
hole on the tube, into its lumen, and out at the distal end. I've found
they work well, and allow a smaller incision to be used than that necessary
to admit both tube and forceps.
Andy Johnston
Senior SHO
General Medicine
Aberdeen Royal Infirmary
AB25 2ZN
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