The incorrect insertion of a chest drain can cause serious harm or even death. All elective drains should be inserted in the 'triangle of safety' in line with the British Thoracic Society guidelines. The aim of this study was to test the awareness of junior doctors involved in inserting chest drains with these guidelines. Fifty junior doctors were questioned. Participants were asked to grade their experience of chest drain insertion and mark on a diagram where they felt was the optimum site for inserting a drain for a large pneumothorax in an elective situation. Only 44% (n=22) of doctors indicated they would insert a chest drain within the safe triangle. Level of experience, seniority and specialty all had an effect on knowledge of the correct site. Of those who had inserted drains unsupervised, 48% (n=16) would site the drain outside the safe triangle as would 75% (n=6) of those who had performed the procedure supervised. Only 25% of medics knew where to insert a drain, compared with 58% of doctors working in surgery. The majority of junior doctors do not have the basic knowledge to insert a chest drain safely. Further training in this procedure is needed for junior doctors.
Hyperlipidemic pancreatitis represents one of the most acute and dramatic consequences of the chylomicronemia syndrome which, if misdiagnosed, can lead to pancreatic destruction and death.
A retrospective analysis of 16 cases admitted to Hamad General Hospital since 1990 investigated the relationship between hyperlipidemia and pancreatitis.
All the patients had discrete, recurrent episodes of acute pancreatitis with typical pain, hyperamylasemia and hypertriglyceridemia. Acute pancreatitis usually occurred when the serum triglyceride levels were above 10 mmol/L. Chylomicronemia, with the serum being visibly creamy, was a constant feature of the lipoprotein pattern of the patients during these acute episodes.
It seems that chylomicronemia is the most consistent feature of hyperlipidemic pancreatitis. Most patients respond well to a low fat diet but lipid lowering agents are generally required to prevent recurrence.
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