Chest tube drain

Why?¶

• It stops bleeding inside the chest. The bleeding normally comes from rib arteries. When blood and air are drained out by the tube, the collapsed lung will expand if the victim breathes deeply. When the lung is fully expanded and presses against the chest wall, the bleeding points are sealed off - and bleeding stops.
• It improves the breathing. The lung collapses when blood and air collect inside the chest cavity. The victim is breathing with the other lung only, but the breathing is poor and rapid. It is urgent to inflate the collapsed lung. That can only be done by a chest tube drain.
• It prevents "stiff lung". If blood is not drained, it clots and forms scar tissue. Non-elastic scar tissue attached to the lung makes the lung stiff.
• It prevents chest infection. All fragment wounds are dirty and full of bacteria - so are chest wounds. Blood collecting inside the chest is excellent food for bacteria. An abscess will form unless the blood is drained.
  

Examination¶

1. Find the wound in the chest wall. Undress the patient completely, wash off blood and dirt. The wound may be tiny - yet it may be life threatening. Also check the victim's back.
2. Compare breathing sounds. The injured lung is partially collapsed, so the breathing sounds are weaker over this side of the chest. Use stethoscope or place your ear at the chest wall and compare the breathing sounds over both lungs. If in doubt: Puncture with needle
3. Insert a large-bore needle (IM size) through the chest wall in the area where you think there are weak breathing sounds. Let the needle slide through the chest wall at the upper edge of a rib in order not to hit a rib artery. One of two things may happen: If air wheezes through the needle when you enter the chest cavity, you probably hit the pneumothorax - insert a chest tube. Or, if you can draw blood through the needle into the syringe, you probably hit the hemothorax: Insert a chest tube.
   

How?¶