ICD tube Examination

chest
Tube
bottle ( 3 important things top exam )
......................................................................................................................
General : well conscious , dyspnoea,respiratory distress , / confortable
fever ( န ဖူး )
cyanosis ( လွ်ာ ၊ လက္ )
clubbing ( လက္ )

Local
Chest : အကႌ်ခၽြတ္ ပါ ။ ပက္လက္ အိပ္ ခိုင္းပါ ။ ေျခ ရ င္း မွ ၾကည့္ ပါ ။

Inspection : respiratory rate and type
shape of chest
movement - normal or decrease on R / L side or paradoxical movemant
accessory muscle movement - working or not

TUBE - plaster --- site ,size
A tube is commingout from that plasterဆို ၿပီး tube အေၾကာင္းဆက္ေျပာ ။
tube --- site - inserted at 5th and 6 th ICS mid axillary line
size - little finger size( serous fluid ) or large size ( empysema )
ကို္င္ ၾကည့္ျပီး texture - soft or ragid
color - clear or not
length - not too long or not too short
အသက္ျပင္းျပင္းရွုခိုင္ၿပီး tube is functioning or not
Anchor stitch --- present
Tube is connected to the under water sealed system bottle
BOTTLE - air/pus ( turbid)/ blood ( red) is seen in bottle about ________ ml
base of bottle is wider or not
air exist /air tube present or not
amount marker ( tape usually )present or not
a plasterid marked at ___ ml ( 2-4 cm from bottle base )

Palpitation :
trachea --- at midline / deviate to R / L
Apex beat ---5th ICS midclavicular line
respiratory movement ----decrease on R / L
chest expension---
vocal fermitus ---
palpable ronchi , pleural rub
surgical emphysema ( ပိုက္ထြက္ေပါက္ ကေန ၿပီး လည္ပင္း ထိ စမ္း ။ လည္ပင္းမွေန ဗို္က္ထိ ႏွိပ္ႏွိပ္ ၿပီးစမ္း ။ ကိြစိကိြစိ ျမည္မယ္ ။
Chest compression test

Percussion : Normal resonance on other side
Hyper resonance( air =pneumotorax ) / stony dullness( fluid =pleural efusion ) on that side
Start from ___th ICS
to ___ th anteriorly
to ___ th laterally
to ___ th posteriorly
Auscultation : (1) normal Vesicular breath sound overthe other side
desrease breath sound on that side and VBS
(2) additional sound - ronchi( ေရ = pleural effusion )
creptation (ျပည္ = emphysema ။ ေလ = pneumothorax)
(3 ) vocal resonance - decrease

Other System: Abdomen : liver , spleen


DIAGNOSIS : R / L sided
intercostal drainage tube
connecting tounder water sealed bottle probably due to R/L - Pneumothorax ( ေလ )
haemothorax (ေသြး )
Emphysema ( ျပည္ )




COMMENT ေပးပါ ဆိုရင္ site ,tube ,bottle ေျပာ ပါ။
Site : 5th and 6th ICS midaxillary line -ၾကိဳက္ ပါ တယ္
most dependent part until supine
all time pleural cavity
confortable
cosmetic
muscle မထူမပါး
wider ICS
7th and 8th ေလာက္ဆိုရင္ - potential space and pleural reces မို ့ အ ျမဲ မ ရိွ ႏိုင္။
ေရွ့မွာဆို ရ င္ - ေဖာက္ ရ ခက္ ၊ ေသြး ထြက္၊ cosmetic မေကာင္း ၊ လက္ လွုပ္ လိုက္ လွုပ္
ေနာက္ မွာဆိုရင္ - muscle ထူလို ့ေသြးထြက္ မယ္ ၊အိပ္ ရ င္ အ ဆင္ မ ေျပ ၊ kinking ျဖစ္မယ္ ၊

Tube : anchor stitch present ( good)
colour - clear ( good )
texture - medium ( good) thick =trauma, soft =kinking
diameter - more wider is better
length - not too long ,not too short ( good)
အဆက္ - ၁ခု ( good)

Bottle : colour - clear ( good)
base - wide ( good )
marker - present ( good )
tube - in the wate ( good )
cap - air exit present ( good)
stand present ( good )



ဘယ္ေတာ့ ျဖဳတ္မလဲ ? indication မရွိ ရင္ ျဖဳတ္ မယ္ ။

Recheck X-Ray-----lung expension
lung pathology
tube postion
Clinically ---- general condition - stable , no dyspnoea
chest - no sign of fluid or air
tube - no air / fluid

စစ္ၿပီး လို ့ ေကာင္းရ င္----နံနက္ေစာေစာမွာ ဆရာႀကီးေတြ ရွိခ်ိန္ မွာ ျဖဳတ္ မယ္
လူ နာ က အဲ ဒီ ျဖဳတ္ တဲ့ အခ်ိန္ မွာ အသက္ မ ရွု မထုတ္ ဖို ့ လို အပ္ တယ္
ဆ၇ာ၀န္၂ ေယာက္---၁ ေယာက္ က ပိုက္ ကို ဆြဲ ထုတ္
၁ ေယာက္ က purse string suture လုပ္

SAFETY TRIANGLE : Anterior axillary fold - P . major
Posterior axillary fold - Lettisimus dorsi
Superior border of 5th rib