BEFORE PLACEMENT
 
TRAUMA PATIENTS
1.      Stable trauma – consult before
2.      Unstable trauma – trauma activation
 
MEDICAL PATIENTS
1.      Primary PTX (ex: young, tall person) – no consult
2.      Secondary PTX (ex: COPD) – no consult
3.      Recurrent primary PTX – consult
4.      Recurrent secondary PTX – no consult
 
In addition to the EPIC consult the involved ED attending should call the trauma attending about the case.
 
DURING PLACEMENT
 
TRAUMA PATIENTS
1.      EM will place the tube on odd days and Surgery will place the tube on even days.  Odd/even switch at 0700.
2.      When EM is on to place the chest tube surgery needs to be present during placement as they will be the ones managing the tube in-house.  This should be a Surgery Chief Resident, Trauma Fellow, or Surgery Attending in the room at the time. 
3.      The EM attending should be sterile and “at the elbow” of the resident placing the tube to ensure proper procedure is followed and the placement is good.
 
MEDICAL PATIENTS
1.       For medical chest tubes that will be admitted to surgery points 1-3 above still apply.
2.       For medical chest tubes that will be admitted to a non-surgical service EM will place the tube and the EM attending should still be sterile and “at the elbow” of the resident placing the tube. 


Admit to TACS if all below criteria are met:
- ED attending believes the PTX needs intervention, AND
- Imaging shows spontaneous primary PTX, AND
- PTX is recurrent (2nd or more on the same side)
TACS should be consulted prior to chest tube insertion.
​
Admit to medicine if ED attending believes the patient needs admission and one of the following criteria are met:
- Imaging shows spontaneous primary PTX or
- Imaging shows spontaneous secondary PTX
In this case, EM provider should perform any necessary procedures without TACS.