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Guidelines for chest drain insertion may not prevent damage to abdominal viscera
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  • Published on:
    RE: Bowness J, Kilgour PM, Whiten S, et al. Emerg Med J 2015;32: 620-625.

    We read this article with interest, given the high prevalence of penetrating chest trauma in South Africa and the fact that we and others (1,2) have published on the challenges faced in high-volume systems with errant tube placement. While we also advocate the "safe-triangle" approach, we aim to place the tube rather in the 4th ICS to avoid the risk of trans-diaphragmatic injury. We are also adamant that the "finger-sweep...

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    Conflict of Interest:
    None declared.
  • Published on:
    Thoracic ultrasound may be a solution

    I agree with the authors that using the guidelines may not avoid subdiaphragmatic viceral injuries. First, many underlying diseases could alter the thorax shape and the diaphragm position. Second, in patients using positive mechanical ventilation support, many different ventilatory strategies, such as lung recruitment strategy, can alter the diaphragm level. Moreover, among some special groups of patients, such as patie...

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    Conflict of Interest:
    None declared.