It's a VBG stupid

We had a patient present with tachycardia. He underwent a chest CT which showed a small subsegmental pulmonary embolism. During my review of his labs, I noticed his PaO2 was 50. Of course! I thought. That surely goes along with a PE.  Well, if I had paid closer attention I would have realized that it was a VBG (venous blood gas), not an ABG. Pay attention. It's a VBG stupid. Hope not to make that mistake again.

The case of the man with blood around his lungs

A few days ago this guy fell and hit his right side. He then came yesterday with shorness of breath and abdominal pain. He had a chest xray which showed a possible pleural effusion. He then underwent a thoracentesis (he has a history of cancer and he was on the medicine team) and they noted over 3 million red blood cells. So they consulted our team, the cardiothoracic service for management of the obvious hemothorax. We went ahead and placed a chest tube. In the process, about 1 Liter of blood came gushing out (and gushing would be the word here). We managed to place the chest tube despite all of the gushing blood. He tolerated that procedure well and remained hemodynamically stable. Hooray for chest tubes. And yes, his chest xray looked a lot better than it did before we placed the chest tube.

The case of the lady who liked to swallow knives and other sharp objects

It's not like children aren't told not to swallow foreign objects. They are. But somehow, this lady didn't get that message. It didn't help that she had a psychiatric illness -- well, actually, according to the psychiatrists that have evaluated her, she has many psychiatric problems, including borderline personality disorder. What she did a few days ago was swallow two steak knives.

Resecting a piece of lung

Today we did a thorascopic wedge resection of a metastatic sarcoma. The patient's left lung was intubated. Her right lung was collapsed. She was laid on her side so that we had access to the right chest. We made a small incision 8 rib spaces from below the costal margin in the mid axillary line. We entered the chest. We then made another incision

The colon cancer that won't go away

Today I saw a man in his 40's in clinic who had colon cancer a few years ago. This was resected and he underwent chemotherapy. Last year he had a CT scan that showed a mass in his liver. It was biopsied and was positive for metastatic colon cancer. He then underwent a liver resection. Unfortunately, he had a CT today which shows multiple discrete lung nodules in both lungs and a possible recurrence of his liver metastasis. We told him that we would discuss his case in tumor board. If it turns out that he has recurrence of his metastatic colon cancer to the liver, then there is no point in resecting the lung nodule.  And to think that he is only in his 40's... I don't know why these things happen.

Getting ready for Cardiothoracic clinic

Yes, today I see patients in clinic. It is a cardiothoracic clinic, but I will be seeing the thoracic patients for 2 different attendings. Here is a run down of the patients who are coming today.

- A 74 year old man who had an esophagectomy who is here for his 3 month follow-up appointment
- A 59 year old man who had an elective VATS and wedge resection of a left lung lesion which turns out to be metastatic melanoma. He is here for a follow-up appointment.
- A 68 year old man who who had a left upper quadrant lobectomy that turned out to be adenocarcinoma.

We are seeing many patients today and this is just a sample of the kind of people we see in the thoracic clinic. 

So this torture called the ABSITE is a yearly exam?

It seems like surgery departments across the nation want to torture us with taking the ABSITE exam every January of our years in residency. Sure, we actually need to know this stuff, but was there not an option to do this more toward the end of the year? Why in january, when a lot of interns are just getting their bearings?