Critical Care Days 3 and 4

Yesterday and today were pretty busy days at school for me on my critical care rotation.  Yesterday morning was rather uneventful but in the afternoon we got heavily involved in a case involving a 2yr old great dane who presented with pneumonia.  He was very thin and he was working very hard at breathing, his sides were heaving everytime he would breathe.  In the early afternoon we took him down to ultrasound where a doctor used the ultrasound to help her take a needle and poke his left lung so we could see what we could get out of his chest.  However, after this, he then developed pneumothorax.  Pneumothorax is literally "air in the chest." Pneumo: air,  thorax: chest.  This is bad because in order for your lungs to expand when you breathe in, there must be negative pressure in your chest.  When room air gets into the chest, then there is too much air pressure pushing on the lungs so the lungs cannot expand like they should.  So, we ended up putting in a chest tube, a tube that goes through the body wall and directly into the chest. We then brought him down to x-ray to take some radiographs to make sure that the tube was correctly placed.  While the x-rays were taking place, I was using a syringe to draw air out of his chest to try to help him out.  After the x-rays, a vacuum was placed onto his chest tube to help suck air out of his chest.  Unfortunately, the cytology (studying the cells that came out of the chest when they poked his lung with the needle) came back as suspicious carcinoma (a type of cancer). The suspicious means that the cells look like they could be carcinoma cells but they could not say that it was definitely a carcnoma. At this point the owner elected euthanasia.  This afternoon, a necropsy was done on this dog and it appeared that the dog did have a severe pneumonia, so bad that only about 20% of his lungs were even usable anymore.  No wonder he was breathing so hard.  When I left, they had not found any evidence of carcinoma but they were not even close to done with the necropsy yet.  Anyways, that one case made yesterday and today pretty interesting.  I have one more day on critical care and then the weekend is here.  However, tomorrow night I am going to be in the ER again just for fun to help out and try to learn some more.