I used to love all those “myths in medicine lectures” as a resident. For a while I collected evidence-based Myth-buster articles like trophies, and to me the truth hunters who unearthed and dispelled these myths were heroic dragons slayers, but it turns out that the dragon is really a many-headed hydra, and I just can’t keep track of how many things I’ve been taught as absolute gospel that have in fact turned out to have no basis in reality whatsoever.
Honestly I’m starting to believe that doctors have a special affinity for believing their own bullshit that is unparalleled in any profession. Wait, can you say Newt Gingrich? Okay, maybe we’re not so bad. Despite my irrational desire to join the republican party and hum along with Mitt that poor people are just fine, I present to you this Myth-busters article that caught my attention after being posted by the folks over at EDTCC:
Does size matter? A prospective analysis of 28–32 versus 36–40 French chest tube size in trauma Inaba, Kenji MD; Lustenberger, Thomas MD; Recinos, Gustavo MD; Georgiou, Crysanthos MD; Velmahos, George C. MD; Brown, Carlos VR; Salim, Ali MD; Demetriades, Demetrios MD; Rhee, Peter MD
In this study there was no difference in any of the clinical outcomes they measured between large and small chest tubes in trauma. So how long have I been pushing 40F tubes into patients for no good reason? I once put a 28F into a little old lady with a large hemothorax (who probably weighed 90lbs wet) because I couldn’t even get my pinky finger past her ribs, and then I never heard the end of it from the trauma service.
While the study found no difference in pain between the small and large size chest tube groups, at least now I can make a choice based on my patient rather than tube size. Thanks Kenji & Co. for lopping off another head. (and nice job on the title).