Correct!
3. Perform a thoracic CT scan

Pushing a tracheostomy tube in place unless there is a clear tract to the trachea is hazardous (1). Placing a thoracostomy tube is reasonable if you are sure there is fluid in the pleural space that needs to be drained. Similarly, penicillin is a reasonable choice for a patient who likely has a lung abcess from aspiration and/or an empyema pending culture results. However, the best answer, and the one suggested by the critical care consult, was to perform a CT scan. The thoracic CT should define whether the tracheostomy tube is outside the trachea and whether there is an empyema and/or a lung abcess.

The patient’s thoracic CT scan is shown in Figure 4.

Figure 4. Selected static images from the thoracic CT scan.

Which of the following is not appropriate therapy?

1. Begin CPAP/NIV for impending respiratory failure
2. Begin penicillin for aspiration pneumonia and empyema
3. Insert a thoracostomy tube for a presumptive empyema
4. Replace the tracheostomy tube with a longer tube under bronchoscopic guidance
5. All of the above are appropriate

Home/Critical Care