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5-S Workplace Organization
Published in Jody Crane, Chuck Noon, The Definitive Guide to Emergency Department Operational Improvement, 2019
The differences, in terms of Lean management, between manufacturing and healthcare tend to become more apparent here, especially as they relate to culture. Because of the occasional critical nature of healthcare, especially emergency departments (EDs) and operating rooms, staff members tend to have a more difficult time removing items perceived as emergency items even when they are not needed immediately. A good example of this is a chest tube. Most EDs have chest tubes available everywhere—in every trauma room. Plenty of prep time is available to bring in a chest cart and set up the procedure, so keeping a chest tube in every room is unnecessary. Even with a tension pneumothorax, the emergent item is a 14-gauge needle throacostomy, and the chest tube is placed in a more controlled manner. Even though these facts are true, most emergency workers will be reluctant to store these items outside of the trauma room in a cart, but by doing so, most departments can carry 80% less inventory and have a much lower risk of obsolescence or expiration.
Response to Acts of Terrorism
Published in Robert A. Burke, Counter-Terrorism for Emergency Responders, 2017
“Blast lung” is a direct consequence of the high-order explosives (HE) over-pressurization wave. It is the most common fatal primary blast injury among initial survivors. Signs of blast lung are usually present at the time of initial evaluation, but they have been reported as late as 48 hours after the explosion. Blast lung is characterized by the clinical triad of apnea, bradycardia, and hypotension. Pulmonary injuries vary from scattered petechiae to confluent hemorrhages. Blast lung should be suspected for anyone with dyspnea, cough, hemoptysis, or chest pain following the blast exposure. Blast lung produces a characteristic “butterfly” pattern on chest x-ray. A chest x-ray is recommended for all exposed persons, and a prophylactic chest tube (thoracostomy) is recommended before general anesthesia or air transport is indicated if blast lung is suspected.
Iatrogenic tracheobronchial and chest injury
Published in Philippe Camus, Edward C Rosenow, Drug-induced and Iatrogenic Respiratory Disease, 2010
Marios Froudarakis, Demosthenes Makris, Demosthenes Bouros
In the setting of haemothorax the main therapeutic options are chest tube placement, thoracoscopy or video-assisted thoracic surgery and early or late thoracostomy. Pleural drainage allows removal of the blood with monitoring of blood loss and can be helpful to decide whether further surgical interventions are necessary. Rapid loss of 1–2 L of blood or ongoing blood loss of exceeding 200 mL/h through a chest tube is an indication for thoracostomy. In cases of severe blood loss, enough blood is matched and general measures for resuscitation are required to correct hypovolaemia and to support an unstable patient.
From plugging air leaks to reducing lung volume: a review of the many uses of endobronchial valves
Published in Expert Review of Medical Devices, 2023
Jorrit B.A. Welling, T. David Koster, Dirk-Jan Slebos
Treatment with one-way endobronchial valves can be an additional treatment option in patients with a persistent air leak (PAL). A PAL is a persistent communication between the bronchial tree or alveoli and the pleural space, and is defined as an air leak that lasts more than five days [43]. The most common causes of PALs are secondary spontaneous pneumothorax due to underlying lung disease (e.g. emphysema), pulmonary infections, complications of mechanical ventilation or lung surgery [43,44]. There are several treatment options in patients with a PAL and a surgical approach is primarily recommended. However, if patients are not eligible for surgery, other options can be explored. Most PALs will resolve with conservative management and other options include chemical or autologous blood pleurodesis and attachment of a Heimlich valve, but sometimes this requires several weeks of chest tube management, either in the hospital or at home [43,44].