Day 4 (09/07) – My First Pleural Tap

9^th JULY 2009 – THURSDAY

8.00 AM

• I arrived at the medical ward at 8 AM. I waited for a while, then I joined Dr. W for the ward round. I followed her checking on few patients, and we arrived at the patient with pleural effusion.
• Dr. W decided that the patient needed another pleural tap. She asked whether I want to perform the procedure, with her assistance of course, and I agreed.
• Then she went to do some clerking, while I sat on a corner revising the steps for the pleural tap procedure.
• After a while, the nurses came and they set up the equipments. I put up my sterile suit with gloves and mask. Then I set up the drape area for the pleural tap on the patient.
• The area chosen was posterior axillary line on the level of 5^th Intercostals space. First, I clean the area with some iodine, then I swab it with alcohol to prevent contamination.
• After that, I prepared the local anaesthetic lidocaine solution. I inserted the needle all the way in, avoiding the ribs, and started pushing the lidocaine diffusedly.
• Then I waited for a while for the lidocain to take effect. After that, I inserted the pleural needle at the same site. I felt the tip of the needle touched the rib, so I avoided it and went at the upper border of that rib.
• I managed to enter the pleural. I took off the needle cap, and few mililitres of pleural haemorrhagic fluid came out.
• There was only few mililitres of fluid. I pulled out the syringe but there was no fluid.
• Dr. W took place, and tried to retrieve the fluid again, but there was no fluid too.
• We then pulled the needle off, and put dressing on the site of injection. Dr. W decided to order a X-Ray to determine the quantity of the fluid. Perhaps the previous 2 procedures had drained a lot of fluid, that’s why there was not much fluid taken today.
• The procedure ended around 11 AM. I went for a lunch break.

2.30 PM

• I returned to work at 2.30 PM. I attended the emergency department.
• That evening, there were few cases of injuries which required immediate attentions
• One of them, a middle-aged construction worker had an accident at the working site. His 5^th phalanx were dislocated 90 degrees at the level of interphalangeal joint.
• The doctors decided to do closed fixation. Local anaesthetic was injected, and the patient was given enough analgesic. One doctor held the patient, and the other one pulled the affected phalanx. The patient screamed in pain, and a click sound was heard as the dislocated phalanx returned to it’s normal location. The patient felt less pain afterwards. He was then sent to radiology for X-Ray.
• My session at emergency department ended around 4 PM. I then was allowed to be free.

Day 2 (07/07) – The Pleural Tap

7^TH JULY 2009

9.00 AM

• I arrived at the ward. Today, my day began with a ward round, lead by specialist Dr. T.  We checked out each and every patient, and while we stopped at a patient, Dr. T asked me about the patient.
• Among the questions asked by Dr. T were about the classification of Thalassemia, the Glasgow Coma Scale, and about the pleural effusion.
• Then, he also asked me to do the history taking and perform respiratory examination of the patient with pleural effusion.
• The patient, 80 years old lady was admitted with complaint of breathlessness. I did respiratory examination, and general inspection showed that diminishing respiratory movement on left side of the lung. There was also tracheal deviation. Auscultation was done, and there was no breath sound at the left side of lung, below 3^rd intercostal space. Percussion was done, and I heard flatness over lower part of left lung. The initial diagnosis was pleural effusion, and it was confirmed by the x-ray.
• Therefore, the doctors decided to do the pleural tap, as well as biopsy of pleura, to determine the nature of the fluid. Dr. B conducted the pleural tap. Here’s what I watched and learnt from her:

Day 1 (06/07) – Reporting For Duty

8.00 AM

• Today is the day I should be reporting in. I arrived at Hospital  around 8 AM. Since today is Monday, there was staff assembly. Therefore I waited for my appointment with the director hospital, Dr. TGS.

9.00 AM

• Dr. TGS came and meet me. There are 2 other medical students that will be doing the practical with me. They are from Crimea State Medical University, Ukraine. Dr. TGS explained us briefly about the rules and regulation of the hospital. She also reminded us the dress codes, and told us the expectations. We also took the chances to introduce ourselves to her.

10.00 AM

• Dr. TGS assigned me with the Head of Medical Department, Dr. T. He is in charge of the Specialist Clinic of Hospital. Therefore I reported myself to him, introducing myself. He then assigned me with one of the MO in charge, Dr. W. I then joined Dr. W in the clinic.
• In the clinic, I swiftly introduced myself to Dr. W, because the consultation is still ongoing. I placed myself at the corner of the room, listening to the consultation between Dr. W and the patients. Dr. W explained to me about the patients, about her approach etc. Among the patients we have this morning was: