This is a picture of an ICU monitor...
Question: What is going on here and what would you do first?
For the answer click 'read more'
Doctors get thought many things that must be done in one sort of way and we do many things because we were thought so! Sometimes it is important though to question standard procedures especially as our knowledge grows rapidly over time.
It's only a couple of years ago many anaesthetists were thought to insert central lines 'blindly' by using anatomical landmarks. X-rays confirmed line placement, ideally in the lower part of the superior vena cava, and excluded complications like a pneumothorax. Line placement in the right atrium was said to cause cardiac perforation and accidental placement in the contralateral subclavian vein often led to re-insertions of new lines. But important questions remains: Is this all really true? What actually do we know?
PulmCrit.org looked into this issue and just posted an excellent little review. Their bottom line is:
Read their post here
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