Chest drains in trauma patients

Adequate training for the insertion of chest drains in a trauma setting reduces the occurrence of procedure-related complications. Prophylactic antibiotics reduce the risk of infectious complications and empyema. For drainage of a traumatic pneumo- or haemothorax a large drain (28-36 French) is advised. The preferential insertion site is the 5th intercostal space in the midaxillary line. Drainage systems consist of a collection bottle, water seal and a suction control. Suction applied at 15-20 cm H2O is recommended for adequate drainage. Conversion to thoracotomy is determined by the drain production. Occult air leaks before removal of the drain can be detected by a temporary water seal or by clamping the drain followed by a chest X-ray. Removal of a chest drain at end-inspiration is as secure as end-expiration. Attention must be paid to potential complications of chest drains.</p

Thoraxdrains bij traumapatiënten

Adequate training for the insertion of chest drains in a trauma setting reduces the occurrence of procedure-related complications. Prophylactic antibiotics reduce the risk of infectious complications and empyema. For drainage of a traumatic pneumo- or haemothorax a large drain (28-36 French) is advised. The preferential insertion site is the 5th intercostal space in the midaxillary line. Drainage systems consist of a collection bottle, water seal and a suction control. Suction applied at 15-20 cm H2O is recommended for adequate drainage. Conversion to thoracotomy is determined by the drain production. Occult air leaks before removal of the drain can be detected by a temporary water seal or by clamping the drain followed by a chest X-ray. Removal of a chest drain at end-inspiration is as secure as end-expiration. Attention must be paid to potential complications of chest drain

Technical Perspective for Video Based Assessment of Surgeries in Low-Resource Settings

Objective: Scalable digital learning environments are essential to sustain surgical training programs worldwide. Detailed images of surgeries enriched with educational annotations are vital to train the eyes of the learners. Here, we report a low-cost method, deployed in a low-resource setting in West Africa, which may contribute to the growth of use in open-sourced digital surgical resources world-wide. Design: This paper is based on the authors participatory and observational experiences creating surgical video content by way of recording surgical procedures and reflecting on field notes and video content. All surgeries were recorded between January and December 2018. Setting: Masanga Hospital, a rural district hospital in Sierra Leone, West Africa. Participants: Thirty-five patients undergoing inguinal hernia repair, elective caesarian section, salpingectomy, bowel resection, hydrocele repair, or below-knee amputation consented for recording their surgical procedure and using the anonymized material for educational purposes. Results: This manual for non-professional cinematographers provides chronological steps for shooting a surgical procedure in a low-resource setting. Recording a surgical procedure to explain surgical techniques, and perform quality assessment through error analysis and coaching requires more than just point-and-shoot. While taking into account local customs and possibilities, practical tips were provided to prepare for the set-up, and recording of a surgical procedure in a low-resourced setting. Conclusion: Commercially available digital video technology allows for filming high-quality surgical procedures for educational purposes at rural district hospitals in a low-resource setting