Written by Jessica DiPeri, MD
This post first appeared on REBEL EM
Background: Pneumothorax management is a common clinical condition in the emergency department (ED) occurring in patients of varying ages and caused by multiple etiologies, including spontaneous, traumatic, and iatrogenic pneumothorax. Regardless of the cause, a thoracostomy is often required for treatment (Currie 2007). Traditionally, all pneumothoraces were treated with large bore chest tubes (LBCT) defined as any tube > 14 F. The benefits of a small bore catheter (ie a pigtail catheter (PC) include less trauma to the chest wall and less patient pain. Additionally, small-bore catheter placement is performed via the Seldinger technique;’ a skill possessed by all Emergency Physicians (Bauman 2018). The decision to use a LBCT vs. a PC in the treatment of pneumothorax has been widely studied over the last decade, yet clinical practice still varies.
Article: Chang, Su-Huan et al. “A Systematic Review and Meta-Analysis Comparing Pigtail Catheter and Chest Tube as the Initial Treatment for Pneumothorax.” Chest vol. 153,5 (2018): 1201-1212. PMID: 29452099 Prospero: CRD42017078481
Clinical Question: Is a pigtail catheter (PC) more effective than a large bore chest tube (LBCT) for treating pneumothorax?
A 68-year old obese female with a past medical history of osteoarthritis, diabetes, and cervical spinal fusion presents to the Emergency Department (ED) complaining of generalized weakness for the last week. In addition, she reports that she had cold symptoms approximately one week before the onset of her weakness. Upon further questioning, the patient also reports numbness and tingling of her bilateral lower extremities. The review of systems is otherwise negative.
TRANEXAMIC ACID (TXA) By: Hima Khamar M.D., PGY3 Tranexamic acid (TXA) has become a huge asset in the world of emergency medicine when it comes to controlling hemorrhage. The main use in the ED is in traumatic hemorrhage, but there are many other uses for TXA. In this article, I will discuss some of the …
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Presenting Resident Nicholas Mota, DO PGY3 Chief Complaint Double vision Brief HPI 30-year-old male with no past medical history presented with acute onset left ocular pain and double vision x1d. Patient states that last night he turned off the light and had immediate symptoms. Patient denies using glasses or contact lenses. Patient has never felt …
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If you are cutting into someone’s chest to put a tube in it, should they get presumptive antibiotics? Check this out
This week’s COTW is about a surprising cause of urinary retention, check it out!
Patients that stink can really hinder an ED. It creates a difficult work environment for ED staff and makes nearby patients, families and visitors uncomfortable. Here are a few ways I came across to neutralize the stank
Let’s face it, we’ve all done it. And, believe me when I tell you all the cool cats are doing it, too. Of course, I am referring to the use of whole blood to determine a woman’s pregnancy status in the Emergency Department using the urine pregnancy test strip. Did you know that the common …
Read more “Just because she cannot pee, does not mean “No UCG””
Placing central venous cathethers, whether under ultrasound guidance or based off of your landmarks can be difficult and still prone to many complications. With the increased use and now standard of care for placing central lines with ultrasound guidance you would think we are immune to the “catastrophic” complication of an inadvertent arterial cannulation. But does ultrasound make us infalliable? Are there other methods that we can use to confirm venous placement of these large catheters?
There’s been a lot of chatter in the twitterverse surrounding the recent release of the POKER Trial out of Australia comparing ketofol with propofol for procedural sedation. Their primary outcomes were looking at respiratory complications, including apnea, desaturation or hypoventilation; with secondary outcomes of hypotension and patient satisfaction. They report “ketofol and propofol resulted in a …
Read more “Throwin’ shade at the POKER Trial”
The weather is finally starting to warm up and the fish are biting. Unfortunately, amateur and pro fishermen alike will also either catch themselves or their friend while out on the waterways this summer. While a small fishhook lodged in a finger may seem trivial compared to some of the more traumatic injuries we see, …
Read more “Gone fishin’”