To Do it Right

Thoracentesis: an important detail

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Thoracentesis: an important detail

Thoracentesis is a clinical procedure with two indications,  the first one  diagnosis, to know the characteristics of the liquid and to obtain a sample for biochemistry, cytology and a culture, and in the second place a therapeutic goal, to allow a normal ventilatory expansion of the lung .

Usually is a safe procedure and the adverse events are related to the possibility of bleeding , pneumothorax and pain.  The tube has to be closed after an amount of liquid is extracted , usually around half a liter every eight hours.

Technical problems: there are some problems associated with the procedure such as an obstruction to the flow and a problem with the insertion.

There is an important detail to keep the procedure on.

Which one do you think  we are talking about?

The tube needs to be cleaned almost every eight hours to maintain the permeability

 

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Case Analysis Theater

Dr.Adolf and the case of allergy to penicillin. Chapter 1.

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Dr.Adolf and the case of allergy to penicillin. Chapter 1.
The storyteller

During the morning, Adolf,the doctor, was attending to a patient with an urinary infection in relation to Escherichia coli. The patient was  allergic to penicillins and the culture showed  sensitivity to Gentamicin, Fosfomycin and Cephalosporin.  The treatment for the Continue reading Dr.Adolf and the case of allergy to penicillin. Chapter 1. →

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To Do it Right

The Pencil of Insuline: use it, but don´t share it

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There are several brands of pencils of insulin, with different activity and different concentration.  There is  a common bad practice when a single pen is used for several patients  with a risk of overdose because different pencils can have different concentration and also the risk of contamination increases with every manipulation.

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Case Analysis Theater

Hydropneumothorax: The Case for Mrs. Dolly

 

Hydropneumothorax: the Case for Mrs. Dolly

Actors

  1. The Intern
  2. The patient (Mrs. Dolly)
  3. The radiologist
  4. The storyteller

THE HISTORY

The storyteller

A 52-year-old woman had a diagnosis of a localized non-small cell lung cancer in her right lung.   She had a right pneumonectomy four months before the actual visit. After a recovery period she started Continue reading Hydropneumothorax: The Case for Mrs. Dolly →

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Others

The piano player and the physical examination

Recently we have been in the Diagnostic Error Meeting in Washington, DC. There the Professor of Surgery of Stanford University Dra. Carla M. Pugh,  showed the importance of a correct clinical examination and palpation to detect a lump in the breast. Force and the technique of examination is important. There is one technique what is less effective to detect a lump in the breast, the piano player technique.

We consider that this concept is also important to detect cervical and supraclavicular lymph nodes.

You can see a video here

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