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Thoracentesis
General Considerations
Both the diagnostic and therapeutic thoracenteses are performed using a similar technique. The major difference is the amount of fluid removed. The proceduralist may also choose to only use the needle technique as opposed to the needle-catheter unit when obtaining fluid for diagnostic purposes only.
It is generally recommended that needle size be limited to 18-gauge or smaller to minimize risk of pneumothorax and damage to nearby structures.
US-guided thoracentesis is associated with a significantly lower rate of complications and has become the standard of care. (1) Real-time ultrasound (US) guidance is recommended for small or loculated effusions when there is concern that the diaphragm or lung tissue is <10mm from the pleural surface. It is also recommended in patients with relative contraindications such as coagulopathies and the mechanically ventilated patient.
March Issue - Annals of B Pod
Spring is here and new beginnings are right around the corner. Step-ups are looming and we will find out the names of our new interns any day. It is time for interns to polish their efficiency, for the R2s to finish their off-service rotations in anticipation of the great variety of the SRU, the R3s to finishing refining their ability to run an effective team. The R4s #fillintheedges of their careers as residents so they can go forth as prepared attendings. In anticipation of these new beginnings, this issue of Annals of B Pod focuses on cases that #fillintheedges.
Grand Rounds Summary 3/9/2016
Back Pain with Dr. Summers
Of the more than 2.5 million ED cases of back pain every year, roughly 5% of these actually have an emergent cause. Conventional red flags include:
- Age >50 or <20 yo
- History of cancer
- Immunocompromised
- HIV
- Steroid use
- IV Drug Use
- Known aortic aneurysm
- Motor neurologic deficit
- Urinary retention, bowel incontinence, or saddle anesthesia