Paracentesis: The Procedure
Discussion: The Z-track method minimizes fluid leakage from the puncture site. Injecting medication into the skin using this method is important to preventing post-procedure leaking. Once a needle has entered subcutaneous tissue and muscle, it opens a track that may not reseal immediately. There are also studies suggesting that Z tracks may reduce pain during injection. We suggest using the method during your paracentesis procedure.Z tracks are used for all kinds of intramuscular injections and can be applied to other sites on the body. Pull and press the skin and tissue 2 cm caudad to the deep abdominal wall and inser...
Source: The Procedural Pause - March 3, 2020 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Using Ultrasound for Paracentesis
Paracentesis can be a quick and simple procedure with the right equipment and a well-rehearsed approach. It's important to practice this skill in the procedure lab and to familiarize yourself with the kit in your department a few times a year. This month, we focus on paracentesis set-up and basics, and next month we will review the nuts and bolts of completing the procedure.Important equipment for paracentesis: Five or six collection bottles, antiseptic prep, and a paracentesis kit. Consider longer needles for abdominal walls thicker than 2.5 cm.Grab the ultrasound and a pen. Position your patient at a 45-degree ang...
Source: The Procedural Pause - February 3, 2020 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Ride the Fluid Wave Before Performing a Paracentesis
Before you break out the bottles for a paracentesis, you may want to consider doing a test for ascites. Many procedures require executing an old-school test before even looking at a result or grabbing an ultrasound machine. Knowing what to look for on a physical exam may guide your practice and intervention dramatically. Using noninvasive tools first could help your patient avoid other tedious or unnecessary testing, which may also result in lost time. Incorporating ultrasound into your practice may also help you nail a diagnosis or allow you to perform a procedure better than you expected.A markedly distended abdomen d...
Source: The Procedural Pause - January 2, 2020 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Primary care uniquely positions us to be our patients ’ best allies
My patient
The day I met you was early in my second year of internal medicine residency. After much of my internship had been spent on arduous inpatient rotations, I was finally ready to lead my own team of young doctors and students on a high-acuity wards service. Yet, in my continuity clinic, I was still fresh, insecure, and naive. The day I met you, your abdomen was swollen, your eyes were yellow, you were drowsy and seemingly apathetic. Years of heavy alcohol use had sclerosed your liver, leading to hepatic disease in its final stages. You were my patient, I was your new primary care doctor — and I didn’t speak you...
Source: Kevin, M.D. - Medical Weblog - September 18, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/ashley-mcmullen" rel="tag" > Ashley McMullen, MD < /a > Tags: Physician Hospital-Based Medicine Source Type: blogs
It ’s time to recognize the rights of medical students and residents
Goodbyes were confusing during my third and fourth years of medical school. Even on my way to a 28-hour labor and delivery call, I tended to say, “I’m leaving for school.” Rather quickly, my wife trained me to say, “I’m leaving for work.” I was never quite reconciled to this, as I couldn’t forget the upcoming exams and tuition costs around $30,000 per year.
For the uninitiated, “work” as a medical student on clinical rotations takes many forms. Talking with and examining patients, participating in team rounds, sewing up skin lacerations in the ED, assisting with various surgeries, contacting outside facil...
Source: Kevin, M.D. - Medical Weblog - June 1, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/thaddeus-r-salmon-iii" rel="tag" > Thaddeus R. Salmon III < /a > Tags: Education Hospital-Based Medicine Medical school Source Type: blogs
LITFL Review 305
LITFL • Life in the Fast Lane Medical Blog
LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog
Welcome to the 305th LITFL Review! Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chunk of FOAM.
The Most Fair Dinkum Ripper Beauts of the Week
What’s on the Trauma Professional’s blog this week? Lots as usual! Learn about bucket...
Source: Life in the Fast Lane - November 5, 2017 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: LITFL review Source Type: blogs
MKSAP: 58-year-old man with hepatitis C-related cirrhosis
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 58-year-old man is evaluated in follow-up for hepatitis C-related cirrhosis that is complicated by nonbleeding small esophageal varices and ascites. His ascites has recently worsened and has required large-volume paracentesis three times per month. He has been on a low-salt diet, spironolactone, and furosemide.
On physical examination, temperature is 36.8 °C (98.2 °F), blood pressure is 98/60 mm Hg, pulse rate is 65/min, and respiration rate is 16/min; BMI is 26. He appears chronically ill. Scleral icterus, ...
Source: Kevin, M.D. - Medical Weblog - October 7, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Gastroenterology Hospital-Based Medicine Surgery Source Type: blogs
MKSAP: 68-year-old man with new-onset ascites
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 68-year-old man is evaluated for new-onset ascites with lower-extremity edema. Symptoms have increased gradually over the past 4 weeks. He has consumed three alcoholic beverages per day for many years. His medical history is notable for coronary artery bypass graft surgery 8 months ago and dyslipidemia. His medications are low-dose aspirin, atorvastatin, and metoprolol.
On physical examination, temperature is 36.8 °C (98.2 °F), blood pressure is 122/84 mm Hg, pulse rate is 64/min, and respiration rate is 16/...
Source: Kevin, M.D. - Medical Weblog - April 22, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions GI Source Type: blogs
LITFL Review 233
Welcome to the 233rd LITFL Review! Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chuck of FOAM.
The Most Fair Dinkum Ripper Beauts of the Week
Cliff Reid deploys bilingual brilliance and teaches us to speak Resuscitese–error proofing common directives in a crisis. [JS]
Richard Body discusses whether compassion is a patient’s right in this great talk from SMACC Chicago. [SO]
The...
Source: Life in the Fast Lane - May 29, 2016 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs
Peritoneal Taps for Removing Ascites Fluids
Paracentesis, or a peritoneal tap, is a procedure emergency physicians often perform to obtain ascitic fluid for diagnostic or therapeutic purposes. Catheter aspiration of fluid is performed to determine the etiology in new onset ascites, to look for infection or presence of cancer, or simply to relieve pressure from a painful, distended abdomen that sometimes can interfere with breathing. Contraindications to the procedure might include an acute abdomen, severe thrombocytopenia, or a coagulopathy. Relative contraindications include pregnancy, a distended urinary bladder, abdominal wall cellulitis, adhesions, or distended ...
Source: M2E Too! Mellick's Multimedia EduBlog - March 1, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
LITFL Review 196
Welcome to the 196th LITFL Review. Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chuck of FOAM.
The Most Fair Dinkum Ripper Beauts of the Week
The Best Case Ever series features Rich Levitan this week discussing the benefits of slowing down how we think, move and perform in order to perform like an expert. [AS]
The Best of #FOAMed Emergency Medicine
Young people can have MIs too. Think...
Source: Life in the Fast Lane - September 6, 2015 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs
Solving the Problem of Delivering Oxygen during Needle Cricothyroidotomy
BY RICAURTE A. SOLIS, DO
When faced with a "can't intubate, can't oxygenate" crisis, the decision to move to a surgical airway must be made rapidly and deliberately. A surgical cricothyroidotomy is debatably the better approach in these situations, but a needle cricothyroidotomy may sometimes be indicated. It may be easier to perform in a very small child, for example, and although it is probably less than ideal in an adult, a rapid needle cricothyroidotomy may provide an oxygenation bridge that will prevent a critically hypoxic patient from arresting until a more definitive airway is secured.
Cricothyroido...
Source: M2E Too! Mellick's Multimedia EduBlog - August 3, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Solving the Problem of Delivering Oxygen during Needle Cricothyroidotomy
BY RICAURTE A. SOLIS, DO
When faced with a "can't intubate, can't oxygenate" crisis, the decision to move to a surgical airway must be made rapidly and deliberately. A surgical cricothyroidotomy is debatably the better approach in these situations, but a needle cricothyroidotomy may sometimes be indicated. It may be easier to perform in a very small child, for example, and although it is probably less than ideal in an adult, a rapid needle cricothyroidotomy may provide an oxygenation bridge that will prevent a critically hypoxic patient from arresting until a more definitive airway is secured.
Cricothyr...
Source: M2E Too! Mellick's Multimedia EduBlog - August 3, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
The ethics of trainee-patient encounters: Are we practicing on the poor?
I performed my first paracentesis in November of my intern year. It was 3 a.m., and I was on overnight call in a packed ICU. The patient, a 45-year-old male with hepatic encephalopathy, was hardly alert enough to remember my name. He didn’t know I was an intern. He didn’t know I’d never even attempted a paracentesis before.
Continue reading ...
Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - August 2, 2014 Category: Journals (General) Authors: Nicole Van Groningen, MD Tags: Education Hospital Residency Source Type: blogs
