BEFORE PLACEMENT

 

TRAUMA PATIENTS

1.      Stable trauma – consult before

2.      Unstable trauma – trauma activation

 

MEDICAL PATIENTS

1.      First time Primary PTX (ex: young, tall person) – no consult

2.      Recurrent primary PTX – consult

3.      First time Secondary PTX (ex: COPD) - no 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.