Just a follow up note to let the list know how this chap got on.
He was admitted for observation to a surgical ward where he was monitored
with SaO2 monitoring and hourly obs. He had a repeat examination and CXR at
6 hours (no change) and again the next morning (still no change). He was
sent home for review in one week with clear instructions to return if at
all symptomatic. Total time in hospital - about 36 hours.
Criticism came from several sources - sadly I believe some of it came from
people who "just fancied a go" at a chest drain!!
Simon Carley
Anaesthetics / Intensive Care
Stepping Hill Hospital
Stockport
England
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> From: Simon Carley <[log in to unmask]>
> To: acadae messages <[log in to unmask]>
> Subject: conservative tx of traumatic chest trauma
> Date: 10 September 1996 11:03
>
> Just a quick request of the lists views.
>
> Case: 55 year old fit and well male falls 4 feet of a ladder onto the
right
> side of the chest. Presents to A+E with right sided chest pain, decreased
> chest expansion and decreased air entry on that side. However, he is
> generally well seen by SHO in A+E and gets an erect AP X-ray.
>
> The film is of good quality and shows a fracture of the 4th rib. There is
a
> small (5cm) area of surgical emphysema seen on the chest film laterally
> which is just palpable clinically. There is also blunting of the
> costophrenic angle - presumably blood. There is no radiographic evidence
of
> pneumothorax (though there must be one).
>
> He is going to be admitted for observation anyway. The question is should
> you put a formal chest drain in this man?? We did not. The decision we
made
> has been criticised by some of our collegues.
>
> Simon Carley
> Anaesthetics / Intensive Care
> Stepping Hill Hospital
> Stockport
> England
> [log in to unmask]
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