Chest tube insertion is a fundamental skill. Here, we review standard tube thoracostomy:
โ๏ธ For traumatic hemo/pneumothorax, small bore chest tubes are non-inferior to large bore chest tubes โก๏ธ28 Fr is the largest tube you need.
โ๏ธ Insert at intersection of anterior axillary
Patrick Georgoff, MD
3,465 posts
๐ฅ Surgeon + Trauma Medical Director @dukemedicine via @UThealthsurg @UmichSurgery @PennMedicine ๐ง @BehindTheKnife co-director & host ๐๐ผDad of 2
- TRAUMA LAPAROTOMY. Know it well! Standard approach: โ๏ธ Stem to stern (xiphoid to pubis) โ๏ธ Take down falciform ligament โ๏ธ Pack all 4 quadrants โ๏ธ Explore systematically โ๏ธ Control bleeding and contamination โ๏ธ Decide: Damage control? ๐งต 1/3
- Replying to @OGdukeneurosurgA video summary (more details in full length)
00:00 - More images from our @BehindTheKnife trauma surgery video atlas. These are from our TRAUMA LAPAROTOMY scenario ๐น
- Penetrating neck trauma? Unstable or hard signs of vascular or aerodigestive injury โก๏ธ OR, otherwise CTA neck. For lateral Zone 2 injuries: โ๏ธ Incision along anterior SCM โ๏ธ Retract SCM laterally โ๏ธ Ligate fascial vein (crosses anterior to carotid bifurcation) 1/2
- Working on a presentation that discusses difficult trauma scenarios. This is what AI thinks a trauma surgeon in a pickle looks like.
- As the surgical maxim goes, donโt mess with the pancreas! But if you do, some general considerations: โ๏ธ Drain, drain, drain. โ๏ธ Consider a staged approach. โ๏ธ RX determined by location of injury, duct involvement, extent of parenchyma destruction, & patient stability
- Replying to @georgoffโ๏ธ Make a ~3 cm horizontal skin incision one rib space below. โ๏ธ Create soft tissue tunnel w/ curved clamp. โ๏ธWith clamp closed, push/pop through intercostal muscles and pleural of rib above skin incision, spread open muscle/pleural โก๏ธ stay on top of rib to avoid injury to
00:00 - To check for bleeding after a splenectomy: โ๏ธ Fold a lap pad into thirds โ๏ธ Unroll it into the furthest reaches of the LUQ โ๏ธ Roll it back up slowly, identifying bleeding as you go
- The resuscitative thoracotomy is a procedure unlike any other. Are you prepared to make a split-second decisionโฑ๏ธ?? Review @WesternTrauma adult guidelines โก๏ธthe new gold ๐ชstandard: pubmed.ncbi.nlm.nih.gov/39451159/ Deep breath... โ๏ธ Big problems require big incisions โก๏ธ edge of sternum
- Pelvic hemorrhage is deadly๐ฉธโ ๏ธ! You MUST have a strategy for managing these patients. โก๏ธ Treat open book pelvic fxs w/ sheet or binder ASAP ๐ขย An effective binder is placed over the greater trochanters (not the ASIS). This decreases pelvic volume, โฌ๏ธ the likelihood of





















