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Is that a tube in your chest…

or are you just happy to see me?  A couple of action shots of a guy who had what was apparently a shrapnel wound to his posterior thorax that resulted in a hemopneumothorax (blood and air in the chest cavity, compressing the lung).  We started an IV, gave him some pain meds & antibiotics, and I placed the chest tube seen here.  We evacuated him to our forward surgical team and he's doing well according to reports.  Yeah, I don't exactly look professional in that first shot, but we tend to joke around a lot during traumas, especially after we have stabilized the patient and know that they're going to do alright. 

I had assisted with a few of these during PA school, but this was the first trauma patient that actually needed a chest tube that I put in myself. During OIF 1 we just never got anyone with penetrating chest trauma that really needed a chest tube.  It's surprising just how hard you actually have to push to penetrate the pleural lining, but it's very obvious once you do. After penetrating and opening the hole up with hemostats there is a great rush of air (in the case of a pneumothorax) and blood (if there's a hemothorax as well) and the patient usually immediately begins to breathe easier, which this one did.  That also explains the last picture (I probably needed a face shield). I'm sure I'll get several more under my belt before I'm done here.