My Medical Skills Give Me Experience Points Chapter 1209: 478: Closed Thoracic Drainage and the Urge to Teach

Pneumothorax gets split into two primary types depending on what causes it: primary and secondary.

For this patient, the first episode of pneumothorax hit after a fit of anger, making it primary pneumothorax. It's way more frequent in guys than gals, hitting a ratio around 6:1.

The key trigger for pneumothorax among men comes from the bursting of subpleural bullae.

Especially, those who are tall and skinny face a higher risk of getting spontaneous pneumothorax.

Once diagnosed, Zhou Can concludes that the patient suffers from left-sided spontaneous tension pneumothorax.

Previously, he punctured the second intercostal space along the left midclavicular line using an 18-gauge thick needle to draw out air from the chest. Yet, the patient continues to battle intense pneumothorax symptoms post-treatment.

A case that seemed straightforward and fast to fix turned complicated in no time.

Gripping the patient's chest X-ray film, he swiftly considers potential fixes.

“Carrying out left-sided closed thoracic drainage to let out the gas could be the right way to treat it.”

Following thorough thought, he chooses to go with this approach for the patient's care.

Closed thoracic drainage has two key signs: one, lung squeeze over 30%, and two, tension pneumothorax. Since this patient fits both, the treatment makes perfect sense.

Inserting the drainage tube in closed thoracic drainage can happen via two ways: cannula or open.

The open way isn't big surgery; it just needs a cut around 1.5 cm long.

Each way follows close principles, with their own advantages and drawbacks.

Zhou Can goes for the open method.

It's straighter forward and brings fast outcomes.

Once he talks to the family, they show huge faith in him and okay the next steps in treatment.

Such trust holds real value.

Since the first needle aspiration didn't work, usual families begin questioning the doctor's skills.

Zhou Can being young could lead families to see him as green and unreliable.

Truth is, the bond of trust between docs and patients matters a ton, boosting the doctor's drive, freedom, and guts to push daring treatment choices.

When families are tough and keep grilling the doctor, it makes the doc go into self-defense mode.

In those spots, safe and simple treatments get picked first, no doubt.

Director Xue jumps in to help fully and sets up a temp surgery spot for Zhou Can right away.

With anesthesia numbing the patient's pleura, the process kicks off.

No need for a full operating room; the ward works fine for this.

Aided by the instrument nurse, he grabs a classic leaf-shaped scalpel and slices a 1.5 cm cut into the patient's chest skin, going through the under-skin layers, then employs long curved vascular forceps to gently spread the muscle until hitting the pleura.

Every move in the surgery flows smooth, fast, and spot-on.

Once at the pleura, he slides the drainage tube carefully through the cleared path into the chest cavity.

It might seem simple, but the whole thing highlights top-notch surgical talent from start to finish.

One minute in the spotlight, a decade behind the scenes.

Truth be told, putting a drainage tube into the thoracic cavity holds clear dangers.

Spreading the chest muscles bluntly to the pleura proves even tougher.

If mishandled, the pleura might rip open, leaving a huge tear in the thoracic cavity.

With the drainage tube placed right, he locks it down tight then hooks it to the drainage setup.

“Can you hear me clearly?”

Zhou Can looks at the patient.

“Yes!”

The patient’s voice remains somewhat faint. Talking sparks chest pain easily.

Post-pneumothorax, even breaths bring agony.

Lots of folks say a breakup causes heart pain so sharp they struggle to breathe. Those signs mirror pneumothorax pretty closely.

“Try taking a deep breath!”

Zhou Can tells the patient to breathe deep.

There's a double aim: check the water column's movement in the sealed bottle first. Second, deep breaths aid the squeezed lung to puff back up fast.

The patient's left lung sits compressed beyond 90%, a dire state.

Getting that left lung to re-expand quick aids healing big time.

“It hurts, it hurts a lot!”

The patient tries a deep breath but halts midway, yelling in agony.

“Prilocaine is still providing anesthesia! Although it’s just local anesthesia, it should relieve some of your pain. You can’t give up just because of a little pain. Continue with the deep breaths, you’re a man. Rest assured, I’ll be here watching; nothing will happen to you.”

Zhou Can urges the patient to attempt deep breathing once more.

Pain stands as a major barrier for tons of patients to push through.

The patient draws a deep breath again, crying out in pain still, yet better than before.

“Okay, stop the deep breathing now!”

Zhou Can halts him, furrowing his brow at the water-sealed bottle. Even with the tube set and linked right, why no movement in the water column?

Good thing negative pressure shows up.

No movement plus no negative pressure means the drainage tube's leaking air or pulled from the thoracic cavity, needing fast fixes.

Zhou Can checks and sees the drainage tube sits secure.

Negative pressure being there means no air leaks.

Just two options left: the patient's lung re-expanded already, or the tube's clogged.

Chances the lung expanded already feel slim.

He figures the clog hit while inserting the drainage tube.

He tweaks the tube and has the patient take another deep breath. Now, the water column moves.

At last, it's sorted.

Looks like the tube went in too far and got stopped by thoracic tissue.