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The pericardium comprises of an outer parietal layer and an inner visceral layer. The pericardium serves multiple functions including: (Marx, 2009)


  1.  Hemothorax
  2. Pleural effusion
  3. Pneumothorax >25% (or any size in patient receiving positive pressure ventilation)
  4. Suspected chest trauma prior  transfer to trauma center
  5. Flail chest req ventilator support
  6. Severe pulmonary contusion w/ effusion

Contraindications (Relative)

  1. Infection over insertion site
  2. Uncontrolled bleeding diathesis

Suggested Size of Chest tubes


Approach to General Toxicology & Toxidromes





The World Health Organization estimates that nearly 1 million people die annually from suicide in the world.  That is equal to one death every 40 seconds from suicide. Suicide rates have increased by 60% in the last 45 years and 5 times the number of people die from suicide compared to armed conflict. (click to see graph of violent death worlwide).

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