Background A thoracostomy tube is a hollow plastic tube or catheter that is used to drain air, fluid, pus, or blood from the intrathoracic space ( Fig. 15.1 ). The word “thoracostomy” combines the prefix “thoraco” meaning “chest wall” and the suffix “stomy” meaning “opening.” Thoracostomy tube may sometimes be referred to as a chest tube (the term that will be used throughout this chapter), intrapleural…
Background Carotid endarterectomy (CEA) is a surgical procedure that involves the removal of plaque from the carotid arteries. Carotid arteries are the two major arteries located in the neck, which branch off from the aorta and supply blood to the brain. Plaque formation in the carotid arteries can result in stroke or transient ischemic attack (TIA). This extracranial atherosclerosis, or blockage in the arteries that supply…
Background Bronchoscopy is an endoscopic technique used to visualize the tracheobronchial tree for diagnostic and therapeutic purposes. The word “bronchoscopy” is derived from Greek words by combining the prefix “broncho” meaning “bronchus” and the verb “skopía” meaning “to view.” Rigid bronchoscopy, which was first used in the 1920s, is less commonly used now, as it uses a more rigid piece of equipment that can only access…
Background A bladder scan is a portable noninvasive ultrasound device that measures the volume of urine in the bladder by using ultrasound waves measured in three dimensions. The machine calculates a volume measurement of urine in the bladder without displaying an image on the screen. Bladder scans are used mostly during inpatient encounters to evaluate patients for urinary retention. Acute urinary retention (AUR) is defined as…
Background Bariatric surgery, or weight loss surgery, is any procedure intended to reduce weight in patients with morbid obesity. Bariatric, translated from Greek, literally means “weight medicine.” Bariatric surgery procedures are classified as restrictive (reduced stomach size; limiting the amount a patient may comfortably eat at any given time) or malabsorptive (alterations to the small intestine length to inhibit caloric absorption). Procedures may be restrictive (e.g.,…
Background An atrial fibrillation (AF) ablation is an invasive procedure that is intended to treat AF. AF is the most common cardiac arrhythmia and is caused by disorganized and rapid electrical impulses in the atria of the heart. In an untreated patient, the ventricular rate also tends to be rapid and variable, between 120 and 160 beats/minute, but in some patients it may exceed 200 beats…
Background The ankle-brachial index (ABI) is a common noninvasive test used to determine if there is occlusive disease of the peripheral vasculature. It uses the brachial arterial systolic blood pressure as the control, assuming it to be nonocclusive, and compares it to either that of the posterior tibial (PT) or dorsalis pedis (DP) arteries. The ABI is calculated in each foot by dividing the higher systolic…
Background The adrenocorticotropic hormone (ACTH) stimulation test is a relatively noninvasive laboratory assessment that involves the administration of a medication followed by the collection of blood samples. ACTH is a naturally occurring hormone released from the pituitary gland that stimulates the secretion of cortisol from the adrenal glands. Cortisol is a glucocorticoid that is responsible for the regulation of fat, carbohydrate, and protein metabolism. The test…
Background An abdominal ultrasound is a test that utilizes pulsed high-frequency sound waves (2–5 MHz) to create images of the abdominal organs without ionizing radiation. It creates real-time two-dimensional images of the various abdominal organs that can be displayed in either the longitudinal or transverse planes. There are a few different versions of the abdominal ultrasound. The right upper quadrant ultrasound, a foreshortened test, only includes…
An anesthesiologist takes care of patients in the periods immediately before, during, and immediately after surgery, which are known as the preoperative, perioperative, and postoperative periods, respectively. In the perioperative period, the goals of an anesthesiologist can be broadly broken down into three components: 1. Keeping the patient safe, above all else. This includes monitoring the patient’s vital signs and responding to changes that may be…
Background Achieving glycemic control is imperative for patients with diabetes undergoing tests and procedures, many of which require dietary restrictions. For these patients, mismanagement of diabetes medications during fasting periods can have dangerous consequences including hypo- or hyperglycemia. This chapter will review glycemic management and guidelines for patients with type 1 diabetes (T1D) and type 2 diabetes (T2D) undergoing tests and procedures in both the inpatient…
General Considerations for Periprocedural Anticoagulation When evaluating a patient on anticoagulation during the periprocedural period, it is important to review the bleeding risk, both for the procedure and the individual patient, and the thromboembolic risk of the patient. The bleeding risk guides how early to hold anticoagulants prior to the procedure and how long to wait after the procedure to restart anticoagulation. The same patient at…
This book embarks on medical tests and procedures and how they interface with pharmacologic interventions. In general, testing can include: ■ The questions asked of patients with chief concerns at their histories ■ Physical exam maneuvers performed on the patient ■ Laboratory, imaging tests, and procedures performed to elucidate further information With each diagnostic intervention, a positive or negative observation is elicited and funneled into the…
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1 What is palliative care? A specialized medical care approach for people with serious illness that focuses on providing relief from the symptoms and stress of serious illness. The goal is to improve quality of life for both the patient and the family. Palliative care is provided by a specially trained team of doctors, nurses, social workers, and other specialists who work together with a patient’s…
1 What changes in organ function occur in advanced age? See Table 18.1 . Table 18.1 Changes in Organ Systems With Aging and Their Consequences System Aging-Related Change Consequence of this Change Skin Xerosis (dry skin) Frequent, diffuse pruritus Cardiovascular Decreased LV compliance and relaxation Elevated LV end-diastolic pressures, greatly increased prevalence of heart failure Renal With loss of muscle mass, decreased creatinine clearance not reflected…
Overview and Approach to the Patient 1 What is localization? The process of determining which part(s) of the nervous system are malfunctioning in order to produce the patient’s signs or symptoms. Localization is key to the neurologic evaluation and often plays an important role in neurology teaching rounds. After the history and physical examination are presented, a discussion begins to “localize the lesion.” A differential diagnosis…
Diabetes Mellitus and Glycemic Disorders 1 List the three main categories of diabetes mellitus (DM) Type 1: Previously called insulin-dependent DM or juvenile-onset DM Type 2: Previously called non–insulin-dependent DM or adult-onset DM Gestational diabetes mellitus (GDM): Diabetes diagnosed in pregnancy 2 Describe type 1 DM Type 1 DM is generally due to autoimmune destruction of the pancreatic beta cells, leading to absolute insulin deficiency, and…
General Issues 1 Define carcinogenesis The alteration of normal cells into malignant cells via a multistage evolution of genetic and epigenetic changes. The cells can escape the normal checkpoints of their host. 2 What are the known gene categories that influence the mechanisms of neoplasia? Oncogenes Tumor suppressor genes Regulators of cell death (apoptosis) Mutation control genes (includes mismatch repair genes) 3 Describe the effects of…
Movement disorders in older adults can be broadly classified into the akinetic-rigid hypokinetic conditions, in which voluntary movement is reduced, and hyperkinetic conditions, in which excess involuntary movements called dyskinesias are present ( Box 64-1 ). Dyskinesias can be further classified into tremor, dystonia, tics, myoclonus, and chorea. This distinction is as not absolute as, for example, in Parkinson disease (PD), the most common akinetic-rigid syndrome,…