Sunday, October 2, 2011

Bad Mim!

Honestly, I'm not sure I deserve to be a resident.  I admitted a patient with pneumonia complicated by pleural effusion.  I performed a thoracentesis (drained fluid in the space between the two linings of the lung) and since the fluid was purulent, foul-smelling, and turbid, I labeled it as empyema.  (Which it was -- see the beautiful Gram's stain below!)

As is protocol when performing a thoracentesis, I ordered a STAT chest roentgenogram to evaluate for iatrogenic pneumothorax.

But did I check the roentgenogram?  No!  I am pretty sure I didn't or perhaps I glanced at it far too quickly.  I assumed my senior was following it.  (Shame on me!)  I also shouldn't have assumed Surgery was reviewing it.  (We consulted their service for chest tube placement to drain empyema.)  While I tried to push for a chest tube overnight to drain the empyema, I didn't realize that I had caused a pneumothorax.  If I had, I would have gotten that chest tube in immediately.  Instead, my poor patient didn't get his chest tube placed until the morning after admission, a good sixteen hours after I created a pneumothorax.  He's lucky he did okay.  He was never symptomatic from his pneumothorax but his pneumonia was so bad that he was already requiring supplemental oxygen at that time.

There must be a special guardian angel looking after my poor patients.  And from now on I will make ABSOLUTELY sure I review post-procedural studies on my patients.

Thank you, God, for getting my patient through a serious medical mistake!  Let's hope he and all the other patients have a speedy recovery.

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