Intercoastal Cathers and Chest Tubes Description Flexible tube is inserted between the ribs into the thoracic cavity to drain intrathoracic, air, blood and other fluids such as pleural effusions, empyema. Aims to allow for lung re-expansion. Indications Pneumothorax – emergency Pleural effusions Empyema -> collection of pus in the cavity Hemothorax Blood collection in pleural cavity. Due to: Trauma Damaged vessel bleed. Chylothorax Leakage of lymphatic fluid into pleural space. Placement Most commonly between the 4 th and 5 th intercoastal spaces between the anterior axillary and mid-axillary lines. Inserted above the superior edge of the rib to avoid injury to the intercoastal neurovascular bundle. A finger should be inserted into the chest tube to tract to maintain patency prior and during the chest tube placement. Contraindications Relative Coagulations Diaphragmatic hernias Pulmonary adhesions from previous surgery Pulmonary disease Pulmonary bullae Thoracic, pleural or pulmonary adhesions Skin infections over the placement area Refractory coagulopathy Hepatic hydrothorax Fluid accumulation in the pleural space due to liver disease. Complications Intercoastal vessel injury Re-expansion pulmonary edema -> due to rapid fluid shifts. Bleeding Infection Effects of hypoxia and hypotension on a patient with a head injury Hypotensive events with or without hypoxia double the mortality and significantly increase the morbidity of severe head injury. Hypotension, but not hypoxia, occurring in the initial phase of resuscitation is significantly (P =.009) associated with increased mortality following brain injury, even when episodes are relatively short. Hypoxia alone does not show statistically significant association with mortality in patients with head injury.