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chest and spine trauma for surgery

Ian Seppelt ian.seppelt at sydney.edu.au
Sat Dec 13 02:31:29 GMT 2014

General comments only [I agree with the way this case was managed]:

- I hope that any anaesthetist capable of doing a major prone spine case
is also capable of inserting a chest drain if necessary
- Watching airway and breathing is fundamental. The only thing that should
distract the anaesthetist from watching the ventilator / respiratory
mechanics would be major haemorrhage. And if there are multiple things
going wrong the only thing the surgeon should be doing is controlling
bleeding, then waiting until everything else is sorted before going on
- My prev comments mainly related to the small pneumothorax seen on CT but
not apparent on CXR. In the days prior to pan-CT these patients would have
gone to the operating theatre, had an anaesthetic with everyone oblivious
to the small pneumothorax, and for the most part come to no harm at all.
- Unnecessary chest drains have a lot of their own complications too,
including long term disabling complications such as chronic pain syndromes
from damage to intercostal nerves. I spend a fair bit of time counselling
juniors (surgical and intensive care) to NOT insert invasive things just
because they can, but to only do so because they are actually necessary!!

Best wishes, Ian

On 13/12/2014 7:47 am, "Doc Holiday" <drydok at hotmail.com> wrote:

>From: ian.seppelt at sydney.edu.au
>> For little pneumothorax only, no chest drain. Just make sure the
>>anaesthetist is aware and knows how to react should there be a
>>respiratory deterioration [I do the anaesthesia for these cases
>--> I am no anaesthetist. I am just thinking here; not just arguing. Is
>there no risk here of the anaesthetist having some other stuff to think
>about and no time to keep an eye closely enough? Stuff goes wrong, no?
>And not everyone is an expert at doping these cases...
>(I draw this conclusion from the fact that this thread is here to discuss
>in the first place!)
>Is prevention with a chest drain in this case not worth the effort for
>"just in case"?
>Again, I am not an O.R. guy - I'm in ED, but my generic teaching tells me
>that, when I teach, I teach those who I don't expect to be experts and so
>we invest some effort in prevention which an expert might not require. So
>my instinct in this case would be that if my patient is about to have
>his/her lungs pressurised and then hidden under a whole bunch of drapes
>and then stuff happened to distract the anaesthetist, then it might be
>best to have a drain in... And leave it to when there is an expert
>around, who is quite confident of being able to deal with what comes, to
>decide to do away with the insurance...
>Does this make sense?
>trauma-list : TRAUMA.ORG
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