9th JULY 2009 – THURSDAY
- 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 5th 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.
- 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 5th 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.