Friday, June 3, 2011

#49 Need medical expertise

#1 Hey, can anybody find anything about injecting antibiotics into the pleural space? After draining four liters of pus out of a hemithorax with a chest tube, I've now had him for three days without any more pus coming out. Normally, after a chest tube, I admit the patient and forget about it. I guess I'll just pull out the chest tube, but can I squirt antibiotics directly into the pleural space just before I pull the tube and suture up? Any evidence that it works? Is there any evidence that replacing my 40-french chest tube with a foley or something is appropriate?

#2 Any ideas what to do with this arm? Burned six months ago, healed with a contracture, then skin broke down and half his arm is covered with granulation tissue, stinky, infected granulation tissue. Looks kinda like the textbook definition of fungating mass. Is it better to cut the arm off?

Olen phone: +235 62 16 04 93
Danae phone: +235 62 17 04 80
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  1. Olen, if you still have this patient with the chest tube that you removed pus out of, you can put antibiotics into the pleural space.

  2. #1: Olen, an old remedy for sclerosing the pleural space is to put in a tetracycline solution so I know it can be done but it may cause the lung to adhere to the chest wall, which isn't the worst thing in the world. It works, and isn't dangerous.

    #2:Olen, you may need to amputate, but I would take him to surgery and see what is underneath that mess. It is possible that you can debride that and get down to healthy tissue, then treat it like a burn with a moist dressing until it granulates in or cover with a skin graft, while stretching the arm so that it doesn't become contracted again. You may end up amputating after all of that, but I think it would be worth the try. Barry Bacon