Case Study: Sudden Death Following Chest Tube Insertion, An Unusual
Case of Vagus Nerve Irrita
tion.
A 36-year-old female developed profound bradycardia within minutes of
insertion of a 28 F
chest tube via the left fourth intercostal space directed towards the
apex of the pleural space for
pneumothorax. The bradycardia did not respond to atropine or
epinephrine. Resuscitation was
unsuccessful. The chest tube had resulted in hemorrhage around the
vagus nerve where it enters the
mediastinum. This resulted in the fatal parasympathetic effect on the
heart. The message appears to
be: limit advancement of chest tubes in the pleural space, and if
bradycardia ensues, be prepared to
pull the chest tube back. The importance of adequate monitoring and
ready IV access in patients
undergoing tube thoracostomy is emphasized. Vagal effects are common
in patients undergoing
invasive procedures. J. Trauma 36: 258, Feb. 94.