This guy was real whiny, complaining, “My chest hurts, my chest hurts.” My very first thought was, “what a wimp”. He was thirty four years old and appeared relatively healthy. What could possibly be causing a 34 year old man so much pain that he was squirming in bed? He wouldn’t look me in the eye and winced everytime I did something to try and examine him.
I felt his calves. No swelling, no tenderness, probably not a PE. I asked his medical history and “social” habits. Pretty low risk for MI. He was thin, but not real tall. His hands and fingers looked normal to me…probably not Marfan’s or aortic root dissection. Hmm. Pericarditis? The really bad cases usually LOOK awful, like they are having a heart attack. This guy was just whiny. I decided it was probably costochondritis and gave him some toradol while we ran some tests.
Go figure…another pneumothorax! My second one in 2 weeks. I later found out that a colleague of mine was waiting for me to finish his chest tube before doing his own chest tube 2 rooms down. Are these things contageous or what?
I wrote a list of orders…we do so few chest tubes at this hospital, and most of the nurses don’t have trauma center experience. So I need to be explicit with everything. You’d think we’d have a nice kit made up, but I needed to call central supply just to get a sterile gown!
Fortunatly, for me and the patient, one of the nurses on orientation had six years of experience in CCU/ICU, but none in the ER. he was very familiar with chest tubes.
I used one of my favorite sedatives again, etomidate, and began the proceedure. The new nurse was extremely helpful, and the tube went in easily. The classic rush of air you read about when putting in a chest tube really happens. And in this case, I watched the patient’s left chest deflate just a bit when I popped through the plural lining of the chest wall. Apparently he had a little bit of tension developing as well.
As I was sewing in the tube I felt very relaxed and not stressed. I realized that it was because of the help of the great nurses at this hospital, and the new nurse in particular who knew how to manage chest tubes, set up the pleurevac, tape a chest tube in place, etc, etc.
As I was finishing up, a tech came in to the room and asked, “Are you guys finished with the critical care cart? Because Dr. Bond needs it 2 rooms down to put another chest tube in.”
I laughed at how smoothly everything went. As I was signing off on the sedation forms, I checked the time of the proceedure from start to finish. Nine minutes. Nifty.
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