Tuesday, March 13, 2012

Chest tubes . . . Respiratory Medicine . . .

One of the most favorite of all my posts has been about the sort of X-Rays that we find at NJH. And to a certain extent it gives you an idea about the burden of respiratory symptoms that we have to deal with at NJH.

Last week, was a bit extra busy with respiratory medicine – we had 3 patients in the wards at the same time with chest tube in situ.

The first to come in was a 70 year old lady with history of pain abdomen for about 6 months with on and off fever. He was being managed elsewhere as cholelithiasis. It was only when one of our doctors wanted to check out her abdomen that he realised that she was becoming breathless. And a cursory examination was enough to come to a conclusion that there was pleural effusion. And it was massive. She made a fast recovery. We removed about 8 litres of fluid. Thankfully, it was clear.

The next one was a young man who had come couple of weeks back and we had diagnosed hydropneumothorax. We had told him about the need for admission and a chest tube insertion. Unfortunately he did not agree immediately. However, he came back after 2 weeks. He’s also made a remarkable recovery.

The third patient was a young unmarried lady who had been sick for about 10 days and was being treated at many places by all sorts of people. Here, it was pus which we drained on putting the chest tube. She has also made a remarkable recovery.

All the three patients have been started on antituberculosis treatment.

Talking about antituberculosis treatment, I just cannot stop talking about the danger of multidrug resistant tuberculosis that is lurking in almost all third world countries. Yesterday, we had a middle aged man with history of treatment with anti-tuberculosis drugs for five times over his lifetime and this was his X-Ray Chest. He was so sick… and terribly breathless.

When I write about Respiratory Medicine, I always think about a bronchoscope that lies unused in our hospital. I pray that we would have a Respiratory Medicine specialist who would be able to strengthen our services and take the hospital to greater heights.

I end this post with this X-Ray which shows a homogenous opacity in a 80 year old lady. We’ve sent her for a CT Scan . . . 

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