- Chest Tube
- Dual Sequence Defibrillation
- Needle Decompression
- Pacemaker/ICD Reset with Magnet
- Pericardiocentesis
- Synchronized Cardioversion
- Transcutaneous Cardiac Pacing
- Transvenous Cardiac Pacing
- Thoracentesis
- Thoracotomy
Chest Tube
Rapid Review
- Background
- Insertion of a chest tube into the pleural cavity to drain blood, air, bile, pus, or other fluids. Allows for continuous, large volume drainage compared to needle thoracostomy.
- Indications
- Hemothorax, pneumothorax, empyema, pleural effusion
- Contraindications
- No absolute contraindication. Relative contraindications include coagulopathy, overlying skin infection, and pulmonary/pleural adhesions.
- Complications
- Misplaced tube (kinked or too deep), infection, damage to nerves/vessels.
Pearls
Dual Sequence Defibrillation
Rapid Review
Pearls
Deep Dive
Needle Decompression
Rapid Review
- Background
- Insertion of a needle (typically 14 gauge) into the pleural space to decompress tension pneumothorax. Typically inserted in the 2nd intercostal space (above the 3rd rib) in the midclavicular line, or the 4th/5th intercostal space in the anterior axillary line.
- Indications
- Suspected tension pneumothorax (progress shortness of breath, asymmetric lung sounds, tracheal deviation, jugular venous distension, hypotension)
- Contraindications
- No absolute contraindications
- Complications
- Lung laceration, kinking of catheter, dislodgement
Pearls
Pacemaker/ICD Reset with Magnet
Rapid Review
Pearls
Deep Dive
Pericardiocentesis
Rapid Review
Pearls
Deep Dive
Synchronized Cardioversion
Rapid Review
- Background
- Defibrillation that is synced to the R or S wave of the QRS complex to avoid energy delivery near the apex of the T wave, which is a vulnerable period for induction of ventricular fibrillation.
- Indications
- SVT, atrial tachycardia, new-onset (or unstable) atrial fibrillation
- Contraindications
- Rhythms requiring unsynchronized defibrillation (pulseless V-tach, V-fib). Caution using for A-fib in patients not anticoagulated (risk of stroke)
- Complications
- Severe bradycardia/asystole. Burns.
Pearls
Transcutaneous Cardiac Pacing
Rapid Review
- Background
- Temporary, non-invasive means of providing ventricular stimulation to the patient’s heart using pads
- Indications
- Symptomatic bradyarrhythmias (AV blocks, sinus node dysfunction, malfunction of implanted pacemaker, etc.)
- Contraindications
- Stable, asymptomatic patients. Bradyarrythmias secondary to hypothermia.
- Complications
- Failure to capture, pain/discomfort, skin burns.
Pearls
Transvenous Cardiac Pacing
Rapid Review
Pearls
Deep Dive
Thoracentesis
Rapid Review
- Background
- Procedure performed to remove fluid from the pleural space for both diagnostic and/or therapeutic purposes.
- Indications
- pleural effusion
- Contraindications
- No absolute contraindications; relative contraindications include coagulopathy or inability to place patient in a safe position.
- Complications
- Pneumothorax, cough, infection, re-expansion pulmonary edema.
Pearls
Thoracotomy
Rapid Review
Pearls
Deep Dive
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