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Morning guys I'm Siobhan a 3rd year medical resident It's the first snowy day of the year, so I'm slipping to work Currently I'm on a respiratory rotation Some people call it pulmonology It's all the same thing it's a specialty of the lungs So today you're going to see the type of things that we do and usually in the winter it gets a bit busier because people get a lot of chest infections So we're starting the day with an hour of teaching So we'll go and meet the team now Not actually sure of the topic As residents we're doctors training to be specialists So our days are filled with learning as well as clinical work So today we're going in depth on how to interpret pulmonary function tests where patients blow into a machine, and then we can figure out the speed of the air and their lung volumes Good morning guys -Good morning After printing our patient lists we're dividing up the list assigning residents and medical students to each of the patients So this is something I don't always get to show you guys One of the best parts of residency is working with great teams of residents And here we might actually be having a little too much fun today, but they do say that laughter is the best medicine Okay so at this point we've divided up our patients We each only are seeing about 3 or 4 patients today We've got a big team which is nice And then any new patients that come into the emergency department or that we need to see we'll just divide it up as we go The first patient that I'm seeing today is a man who was admitted last night for hypoxia He gradually had become more short of breath over a few weeks and became concerned, so he went to see his family doctor When he arrived at the clinic his oxygen saturations were only 73, so he was immediately sent to the emergency department Okay so this patient has a lot of fluid on just one side of the lung which is called a pleural effusion Now that can be for a lot of different reasons Some of them are really serious like cancer or infection that can get stuck there And other times it's not as serious, but we won't know until they actually get some fluid off of that and analyze that under the microscope So that's what we're going to do I'm going to go get the supplies, and we're going to do something called a thoracentesis Getting supplies and setting up often takes the most time So during that time I like to actually visualize the procedure to help me prepare mentally and also, so I don't forget anything I'll be using ultrasound to put a needle through the patient's back just on top of one of his ribs, and I'll be draining out the fluid from his chest The goal is to take off fluid and then decompress the lungs so that he can breathe better but also so that we can make a diagnosis So I'll be sending off the fluid in different containers and sending a bunch of tests including bacterial culture getting a cell count and differential to see what types of cells are in there and also cytology and flow cytometry to...
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