PRN_NURS

HodgieRN is absolutely correct, The wet seal is essentially the original way of chest tube suctioning, and the last picture provided is exactly what the chest drainage devices use to look like. Just a point to remember, when there are air bubbles in the water seal/air leak meter it does not always mean there is a leak; Know what is being drained from the pleural space because when draining a pneumothorax there should be air bubbles present (though they should be decreasing as time goes on). as well, when using dry suction, be sure the suction monitor bellows indicates that suction is in fact working (i have seen this as a accordion type spring, as seen in first pic above, and as a check mark). When using wet suction, be sure the suction control chamber is not only set to the right pressure, but that there is a constant, gentle stream of bubbles through it, this indicates suction is working properly. cheers

If the link does not work its probably because you need an account (which is free). Go to medscape and search "Methemoglobinemia in emergency medicine."

Methemoglobinemia was the first thing I though of when reading this case, I'm glad to know I was right; though I had a similar case not to long ago. I thought I would add resource for people who would like to learn more on this: http://emedicine.medscape.com/article/815613-overview the reason your SpO2 was low was because your patient probably had low-level Methemoglobinemia which results in low readings. Whereas, high-level Methemoglobinemia would have resulted in a normal false SpO2 reading. Important Note**** this is a great example of how the SaO2 we get from our ABGs are not always accurate. SaO2 from ABGs are usually calculated not measured from our measured PaO2 ( a measured SaO2 would come out low). However, a PaO2 will come out normal with Methemoglobinemia, beause it is normal. The issue with Methemoglobinemia is not the amount of O2 but the change in our hemoglobins affinity for O2. However, the problem for the patient is the same. No O2 to tissues = hypoxia and death. Great case !! thanks for sharing.