Spontaneous Pneumothorax – Just like House did it

Today, my favorite x-ray tech emerged with a chart from a patient whom he took from the waiting room to do a chest x-ray.  Waiting times in our ER today were 3-5 hours long, so a little bit of time is saved by taking patients straight from the waiting room to the x-ray area.

So Curly the tech came out waving a chart.  “Somebody needs to put a chest tube in this kid,” he nonchalantly stated to nobody in particular.  He ceremoniously spun a slow 360 degrees to see if anyone was listening, then shrugged his shoulders, dropped the chart off to the charge nurse and went back to his dark room, his job was done.

A colleague who ended up with his chart a few minutes later asks, “How would you like to to a chest tube in 10, while I do a spinal tap in room 11?”

Hmmm…when was the last time I put a chest tube in?  It’s been awhile…I think in Colorado last summer when a lady who was choking developed a pneumothorax after receiving the heimlich maneuver.

After evaluating the young man, I wrote some brief orders to get things started.  The problem was, none of the nurses had ever done a chest tube before!

We recruited two nurses from other zones, one of whom has done countless chest tubes in our ER, the other has worked at a trauma center before, but it was her first day at our hospital.

So without going through all the details of putting in a chest tube, the process was quickly completed.  His nurse administered sedation was perfect, he fell asleep while I made the initial incision and placed the tube.  As the nurse were joking to themselves the patient started laughing.  He was asleep, but listening and laughing at our jokes!

Curly repeated the chest x-ray and it looked beautiful with a fully expanded lung.   Another life saved.

  5 comments for “Spontaneous Pneumothorax – Just like House did it

  1. February 6, 2008 at 7:03 am

    I love chest tubes. More satisfying than just about any other ER procedure. Easy and fun. Wish I got to do ’em more often. I guess I should go back and work at the trauma center for a while.

  2. Jared
    February 6, 2008 at 12:55 pm

    I’m not sure about the nonchalant part of the tech (I’d probably give him a gentle talking-to about–this definitely falls under the purview of “kills people dead”) but, good save, doc!

  3. Doug
    March 11, 2008 at 8:30 pm


  4. March 22, 2008 at 12:59 pm

    Ah, Spontaneous Pneumothorax! I had one of those, back in the late Spring of ’04.

    Waited a week to go to the ER. (Would rather eat worms than talk to medical people.)

    I input my symptoms into the “Family Doctor” website, that’s the diagnosis the ‘bot came up with.

    Surprise! That’s what it was! For the time before I went in, I was short of breath, and could feel my chest contents shift when I turned over in bed. It hurt, too.

    When I finally got to the ER, the surgeon (once I got past the asshole who first looked at me) stuck me with a chest tube; a big one.

    He said, IIRC, “I like to make a big enough hole to stick my finger in and feel what’s up in there.”

    Funny, “Band of Brothers” was showing on the TV in my treatment alcove while this was going on, with revoltingly realistic casualty depictions. Made me not mind my own pain quite so much

  5. MCA
    May 21, 2008 at 2:24 am

    I don’t understand Jareds remarks. What exactly is it you think the x-ray tech should have done? He pulled the kid out of the waiting rm. he did the x-ray, took it to the ER and stated “Someone needs to put a chest tube in this kid.”

    Obviously if Shazam heard him make these remarks he made certain they knew what was going on and then he left his reports with the charge nurse….

    I dont know what else he should have done unless you think maybe he should have been in a panic running, yelling and screaming through the halls of the ER?

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