Chest Drain Insertion in Adult Trauma Case 1

Revisit scenario 1 from the beginning of the session.

A large 110 kg, 30-year-old man has fallen off his horse, whilst riding after lunch. His proven injuries on completion of the primary survey are:

His chest x-ray is shown (click on the x-ray to enlarge).

What are the indications of a chest drain insertion?

You have elected to CT scan his chest and abdomen prior to orthopaedic theatre and feel chest drain insertion is justified beforehand.

Click on the image to enlarge.

What modifications to your chest drain insertion technique might you consider in this case?

Your consultant asks whether antibiotics are indicated following chest tube insertion in trauma cases?

Which of the following statements regarding empyema rates following chest drain insertion after trauma are correct?

Select one or more options.

The empyema rate is likely to be between 5-10% in patients not given antiobiotic cover
The empyema rate is likely to be between 2-5% in patients not given antiobiotic cover
Prophylactic use of 24 hours of IV cephalosporin or clindamycin effectively reduces rates to <1%
Prophylactic use of 24 hours of IV cephalosporin or clindamycin effectively reduces rates to <3-5%

The patient’s subsequent CT scan demonstrates that your tube lies within a fissure.

What is your response?