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Sat Mar 17 13:21:02 GMT 2007

Dear dr danks,

clearly your decision to ask this question suggests a patient whom you believe is at the end of care;  otherwise you would have already replaced a non functioning tube with an appropriately placed one, taken a chest x ray the day following and booked his VATS if still unsuccessful. What motivates you to abandon the normal care in a patient who has limited useful time and who may want to return to his home as quickly as possible instead of being confined to hospital while his doctor dithers?
Tom

> ----------
> From: 	trauma-list-bounces at trauma.org[SMTP:trauma-list-bounces at trauma.org] on behalf of Roy Danks[SMTP:roydanks at hotmail.com]
> Reply To: 	Trauma &amp; Critical Care mailing list
> Sent: 	sexta-feira, 16 de março de 2007 20:21
> To: 	trauma-list at trauma.org
> Subject: 	(no subject)
> 
> 63 y.o. male falls in bathtub and has multiple, displaced left rib fx, hemopneumothorax.  Also has fairly recent dx of Stage IV colon CA (mets to lung and liver)...mets in the affected (traumatized lung).  Now 8 days post injury and has retrained HTX (probably 300-500 ml...who knows, it's compressing and causing atelectasis, but no hypoxemia)...and about 15% PTX.  Chest tube not in good position really.
>  
> Do I:  Replace the chest tube?  Do a VATS, evac the clot and place chest tube(s) then or do nothing and see what happens?
>  
> Thanks.
>  
> R. Danks
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