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Chest drain complication — SCE Acute Medicine MCQ

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ModerateProcedural Knowledge and Acute Management DecisionsChest drain complicationSCE Acute Medicine

A 74-year-old woman is assessed on the acute medical unit. A large chronic pleural effusion is drained rapidly and she develops cough, chest tightness and hypoxia. The bottle contains 1.8 litres. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most important immediate action?

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Correct answer: A — Clamp the drain and assess urgently for re-expansion pulmonary oedema

Clamp the drain and assess urgently for re-expansion pulmonary oedema is the best answer because symptoms during rapid drainage suggest re-expansion pulmonary oedema risk and drainage should be stopped while assessing. Give high-flow oxygen and prepare for airway support is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Large effusions should be drained in a controlled manner.

Reference: BTS Pleural Disease Guideline