Podcasts about paracentesis

Welcome to the emDOCs.net podcast! Join us as we review our high-yield posts from our website emDOCs.net. Today on the emDOCs cast with Brit Long, MD (@long_brit), we cover the literature on evaluation and management of primary SBP. To continue to make this a worthwhile podcast for you to listen to, we appreciate any feedback and comments you may have for us. Please let us know!Subscribe to the podcast on one of the many platforms below:Apple iTunesSpotifyGoogle Play

Dr. Karen Brown explains how she improved paracentesis workflow by creating a service that has shortened procedure time, decreased hospital length of stay, and improved patient and referring provider satisfaction. --- CHECK OUT OUR SPONSOR GI Supply RenovaRP Paracentesis Pump https://www.gi-supply.com/products/paracentesis-management/renovarp-pump/ --- SHOW NOTES In this episode, host Dr. Aaron Fritts interviews Dr. Karen Brown, Section Chief for Interventional Radiology at the University of Utah about how she improved workflow by creating a paracentesis service that has shortened procedure time, decreased hospital length of stay, and improved patient and referring provider satisfaction. Dr. Brown begins by reviewing the standard workflow for performing paracentesis before implementing her new program. She says paracentesis used to be done in a procedure room, and would often take quite long, delaying other procedures that were a better use of the room. Though a simple procedure, paracentesis can take quite some time to fully drain the ascites. Dr. Brown and colleagues conducted a trial that compared standard wall suction to the Renova pump. Patients preferred Renova due to less capturing of bowel and adjusting of the catheter. They found that by using the Renova pump, they could cut the procedure time down by almost half. She says that hiring an advanced practice provider (APP) that was designated to paracentesis was key to improving the efficiency of the daily IR workflow. The other advantage to Renova is its portability. She says that this helped her get paracenteses out of procedure rooms because the APP can now do paracenteses anywhere, even at the bedside for an inpatient. We end by discussing recommendations for IRs who are interested in improving efficiency in their practices. Dr. Brown says that the key is to make the case to administrators or purchasers that procedure room time is money. By speeding up the process for paracentesis, she has also been able to increase the number of paracenteses they do per year and decrease hospital length of stay for patients who are waiting for a paracentesis before discharge, which has saved both time and money. --- RESOURCES Dr. Brown's publication in Diagnosic and Interventional Radiology: https://www.dirjournal.org/en/paracentesis-faster-and-easier-using-the-renovarp-pump-132424 RenovaRP® Paracentesis Pump: https://www.gi-supply.com/products/paracentesis-management/renovarp-pump/

Contributor: Peter Bakes, MD Educational Pearls: Paracentesis is a procedure where fluid is removed from the peritoneal cavity by needle Indications for paracentesis include: large volume paracentesis (5-6L), diagnosis of transudative or exudative ascites, evaluation for spontaneous bacterial peritonitis (SBP) Infection of ascitic fluid is more likely in transudative processes due to the increased frequency of paracentesis E coli is the most common pathogen to cause SBP Treatment with 3rd generation cephalosporin, like ceftriaxone References Aponte EM, Katta S, O'Rourke MC. Paracentesis. [Updated 2020 Sep 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK435998/ Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD

A retrospective cohort study in the Journal of Hospital Medicine looks at timeliness of paracentesis performed by a hospitalist procedure service. Impact of a Hospitalist-Run Procedure Service on Time to Paracentesis and Length of Stay | Hospital Medicine Virtual Journal Club

In this part 2 of our 2 part series on Liver Emergencies we clear up the confusing balance between thrombosis and bleeding in liver patients, the elusive diagnosis of portal vein thrombosis, spontaneous bacterial peritonitis diagnosis and treatment and some tips and tricks on paracentesis with Walter Himmel and Brain Steinhart.... The post Ep 149 Liver Emergencies: Thrombosis and Bleeding, Portal Vein Thrombosis, SBP, Paracentesis Tips and Tricks appeared first on Emergency Medicine Cases.

  Contributor: Sam Killian, MD Educational Pearls: Spontaneous bacterial peritonitis (SBP) is an infection of peritoneal fluid that typically occurs in cirrhotic patients Symptoms may include abdominal pain, fever, and/or altered mental status Paracentesis is diagnostic test of choice. Diagnostic criteria includes > 250 polymorphonuclear cells (PMNs) or a positive gram stain/culture Treatment is typically a 3rd generation cephalosporin ·30-40% of SBP patients will go into renal failure and SBP associated with sepsis has an ~80% mortality References Dever JB, Sheikh MY. Review article: spontaneous bacterial peritonitis--bacteriology, diagnosis, treatment, risk factors and prevention. Aliment Pharmacol Ther. 2015 Jun;41(11):1116-31. doi: 10.1111/apt.13172. Epub 2015 Mar 26. PMID: 25819304. MacIntosh T. Emergency Management of Spontaneous Bacterial Peritonitis - A Clinical Review. Cureus. 2018 Mar 1;10(3):e2253. doi: 10.7759/cureus.2253. PMID: 29721399; PMCID: PMC5929973.   Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD   The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at www.emergencymedicalminute.com/cme-courses/ and create an account. 

Dr. Víctor Torres Gastroenterólogo Tema: Paracentesis // El virus de la Hepatitis C

El síndrome hepatorrenal y la lesión renal aguda en pacientes con cirrosis son dos de los temas más apasionantes y difíciles en la medicina. Acompáñenos en este episodio para redescubrir este síndrome. Time Stamps:   Introducción: 00:00 Primer caso clínico: 05:38 Evaluación inicial de pacientes con cirrosis y lesión renal aguda (LRA): 06:50 Fenotipo del paciente con riesgo de desarrollar síndrome hepatorrenal: 08:56 Problemas con los criterios previos para el diagnóstico de síndrome hepatorrenal: 10:45 Factores desencadenantes de síndrome hepatorrenal: 12:20 Consideraciones de la creatinina en pacientes cirróticos: 13:13 Tipos de síndrome Hepatorrenal: 14:00 Principales riesgos para lesión renal aguda en pacientes cirróticos con lesión renal aguda: 14:42 Fisiopatología del síndrome hepatorrenal: 17:30 El síndrome hepatorrenal tiene un espectro de manifestaciones, no es blanco y negro: 19:45 Fracción excretada de sodio y su utilidad en síndrome hepatorrenal: 20:51 Microscopía urinaria en el abordaje de síndrome hepatorrenal: 21:40 Papel del corazón y la presión arterial en la fisiopatología del síndrome hepatorrenal: 22:58 Point of Care Ultrasonography (POCUS): 27:38 Diagnóstico diferencial de nefropatía por cilindros biliares: 31:17 Paracentesis en pacientes con cirrosis con LRA y uso de albúmina profiláctica: 34:30 Tratamiento del síndrome hepatorrenal: vasopresores: 39:48 Tratamiento del síndrome hepatorrenal: albúmina: 46:30 Tratamiento del síndrome hepatorrenal: diuréticos: 51:16 Puntos para llevarse a casa: 55:04    

En este episodio grabado en junio de 2018. Asisto una vez más a realizar una paracentesis. Me dan malas noticias, pues me comentan que el hígado está empeorando y ocuparé paracentesis con mayor frecuencia!!! Follow me/Sígueme: Facebook: Dr Alfredo Castaneda Instagram: dralfredocastaneda YouTube: https://www.youtube.com/channel/UC4w_lZOlmi37ERMz3HKxGDA Podcast: Dr. Alfredo Castaneda Mailing address/Correo de contacto: Alfredo Castaneda P.O. Box 3491 Chula Vista, CA. 91909 Dr. Alfredo Castañeda-Meave N.D.

Cirrhosis TIPS for the decompensated cirrhotic & acute on chronic liver failure from expert hepatologist and keto-practitioner Scott Matherly MD, @liverprof and chief hepatologist at @KashlakHospital. We walk through acute management of variceal bleeds, when to suspect SBP in decompensated cirrhosis (all the time, it turns out), how much fluid to remove in paracentesis, and some definitions about what decompensated cirrhosis and acute on chronic liver failure really mean. Take our pretest on cirrhosis! Full show notes available at http://thecurbsiders.com/episode-list. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written and produced by: Nora Taranto MS4, Matthew Watto MD Pretest by: Cyrus Askin MD Hosts: Matthew Watto MD, Paul Williams MD, Images and infographics: Hannah Abrams MS3 Edited by: Matthew Watto MD Guest: Scott Matherly MD Sponsor  Get your ACP membership today and use the code CURB100 to save $100 when you join by March 31, 2019. Time Stamps 00:00 NephMadness teaser 00:50 Sponsor - Become an ACP Member today! 01:25 Intro, guest bio 03:45 Guest one-liner, keto diet 07:40 Picks of the week from Paul, Matt and Scott 11:50 Sponsor - Become an ACP Member today! 13:26 Clinical case of bleeding and altered mental status in cirrhosis 16:10 Interpretation of our patient’s labs and physical exam 18:53 Defining terminology in cirrhosis (decompensated vs compensated vs acute on chronic liver failure) 24:48 Initial workup, resuscitation and stabilization in variceal bleeding 26:10 Why occult blood and ammonia levels are unhelpful in cirrhosis 29:00 Fluid choice for the cirrhotic patient with hypotension; octreotide (or terlipressin); antibiotics prophylaxis 33:10 Proton pump inhibitors and ulcers from variceal banding 34:00 Mechanism of action for octreotide and terlipressin 35:54 Prevention of recurrent bleeding with TIPS, or nonselective beta blockers 40:40 Scores for prognostication in the acute setting 44:00 Coagulopathy of cirrhosis and should DVT prophylaxis be used 48:38 Elevated INR and procedures 56:55 Paracentesis in the acute setting and interpretation of fluid studies:cell count, total protein, SAAG, blood culture vial; pathophysiology of ascites 67:30 Treatment of SBP: antibiotics, IV albumin; plus, Hepatorenal physiology explained 79:04 Hepatic encephalopathy is a shunt phenomen; how to evaluate for causes; treatment of HE 87:58 Rifaximin 89:10 Take home points 91:02 Outro

Gina Rapacz is a 48 year old mother of 2 teenage daughters living in the Chicago suburbs.  She recently had a liver transplant after hers failed and she lingered on the transplant list in Chicago for over a year.  Her transplant was completed at Duke Medical Center in Durham, NC. She is now on her way to a healthier life with a new liver. See Transcript of this show below. Transcript  Lita: [00:00:16] Hello and welcome to podcast DX. This show that brings you interviews with people just like you whose lives were forever changed by a diagnosis. [00:00:24][8.7] Lita: [00:00:26] I'm Lita. [00:00:26][0.2] Ron: [00:00:27] I'm Ron. [00:00:28][0.2] Jean: [00:00:28] And I'm Jean Marie. [00:00:28][0.6] Lita: [00:00:29] Collectively we are the hosts of podcast d x. This podcast is not intended to be a substitute for professional medical advice diagnosis or treatment. Always ask the advice of your physician or other qualified health care provider for any questions you may have regarding a medical condition or treatment and before undertaking any new health care regimen. Never disregard professional medical advice or delay in seeking it because of something you have heard on this podcast. [00:01:03][33.5] Ron: [00:01:05] On today's show we will be interviewing Gina a liver transplant recipient. [00:01:09][3.8] Jean: [00:01:10] Gina is a 48 year old from a Chicago suburb, where she lives with her husband two teenage daughters Nikki Sarah and their adorable puppy. Coco. [00:01:18][8.1] Lita: [00:01:19] Hi Gina thank you for joining us today. [00:01:21][2.0] Gina: [00:01:22] Hello. Thank you for having me. [00:01:24][1.2] Ron: [00:01:25] I understand it's been almost six months since you had a liver transplant. Yes I was transplanted September 30th 2017. [00:01:32][6.7] Gina: [00:01:33] In North Carolina at Duke University Hospital. [00:01:35][1.6] Lita: [00:01:36] Well you look great. [00:01:37][0.6] Gina: [00:01:38] Thanks. I actually I feel great. This is the best I've ever felt actually. For. A long long time. [00:01:43][5.4] Lita: [00:01:43] . Gina, what symptoms first led you to the doctor. [00:01:48][4.8] Gina: [00:01:49] Well. As far back as I can remember 2016 I had a really bad swollen. Ankles from water retention. Very tired. I was always cold. The doctors were. Thinking I had cancer. Which. Led my disease to. Worsen. As they were testing me for cancer. But it was not. [00:02:11][21.6] Jean: [00:02:13] How long did it actually take before you got. A correct diagnosis? [00:02:15][2.1] Gina: [00:02:17] My symptoms were bothering me for at least five months before they diagnosed my liver problem. [00:02:21][4.4] Ron: [00:02:24] Gina, Can you recall any specific symptoms that really stood out. [00:02:27][3.2] Gina: [00:02:28] Yes of course. My stomach. I look like I was nine months pregnant. And the build up of ascites is a toxic fluid. That forms in your stomach. Making it. Enlarged. My eyes were no longer clear they were. Foggy. and my skin was chapped & itchy. Always thirsty. Almost like you want to stick your head in the swimming pool. I lost my appetite. I had dry heaves almost throwing up but not quite. Always had leg cramps. My calves were so painful they'd wake me up at night. I would try standing up. They were. Very. Painfully twitching. And the muscles would cramp up. You. It's like a charlie horse times 10. Very painful. Terrible terrible. [00:03:13][45.0] Lita: [00:03:14] Were there any embarrassing symptoms that you had? [00:03:17][2.5] Gina: [00:03:18] Yes I actually would. I, I had. A bad case of diarrhea all day I would go maybe eight to 10 times a day never knowing when it was an attack. But usually when I was at Target or Wal-Mart shopping. And I would have to use a public bathroom for no reason at all my nose would start bleeding. And. It was on a daily basis. [00:03:43][24.7] Jean: [00:03:44] Did anything help relieve any symptoms. [00:03:46][1.3] Gina: [00:03:47] Well for the chills I would layer up. I would layer clothes use the electric blanket at night. wear socks, which, I am not a socks person. I also spend time in the sun which helped. I never used air conditioning or a fan never wanted to cause a breeze my way because the chills. You can never. you, that feeling was intense. [00:04:07][20.3] Ron: [00:04:10] You mentioned that you're always thirsty. How do you deal with the thirst. Even though you're thirsty all the time. [00:04:17][6.7] Gina: [00:04:18] The doctor puts you on a water intake a day. So I was on a two liter a day intake. Of liquid. After. My water intake. I would move over to a frozen. freezy pop. Like a Popsicle. Yeah because a popsicle had flavor to it and it would break up the monotonous taste of the water. Also. They give you a little sponge like. Device at the doctor's office where you dip it in water. And you kind of stuff the water on this little sponge. And that helped. [00:04:48][30.6] Lita: [00:04:51] Did anything help with the swelling that you had? [00:04:54][3.0] Lita: [00:04:55] Your stomach was swollen. [00:04:56][0.6] Gina: [00:04:57] Yes actually. There's a procedure they call Paracentesis. [00:04:59][2.6] Lita: [00:05:00] Wait a minute, Paracent- whatis? [00:05:01][0.3] Gina: [00:05:02] Paracentesis. you're in the hospital outpatient. Procedure where they go in. To your stomach with a needle like, device. And they hook up the hose, to a JAR, glass jar liters and the fluid is flushed out of your stomach. Out of your abdomen. Very painful. But. When you leave. After that. Procedure. You're about five to six liters. Of fluid. Down. Where the relief is amazing. [00:05:35][32.5] Lita: [00:05:36] So besides the Paracentesis. Was there anything else that you. Could do that would help the swelling. [00:05:41][5.4] Gina: [00:05:43] Yes, you could watch what you eat. Restricted salt diet and limiting my fluid intake helped the swelling. At night we tried to get comfortable by putting a wedge under my legs. To help with the cramping. When the cramping got real bad. I tried to walk it off. As early as I could. Sometimes when you check the sodium levels of the food that you're eating you'd be shocked that a lot of things have sodium. So. You do have to read labels and watch your sodium intake because that will cause fluid to accumulate in your stomach. Also I was a member at a health club that I had access to a Hot water Jacuzzi. Which helped. My legs in the cramping and feel less tense. I suggest that for anybody. And also. I self meditate. Myself out of pain. And that helped me get through a lot of my symptoms. [00:06:37][54.2] Lita: [00:06:40] Well that's really great. That's probably a good suggestion for anybody. Did you know what to expect when your doctors. Actually inform you that you have cirrhosis and now end stage liver disease? [00:06:53][13.2] Gina: [00:06:54] I didn't even know really a part of cirrhosis of the liver but I never really knew what. It. Was or what it untailed. I assumed it was kind of like if somebody had a heart attack. You go into the emergency room. You get back to a goal you undergo surgery. And. That's the end of it. I do not know. What end stage liver meant. But. It was. They gave me weeks to live. And that was scary because you're you don't know what to expect. Day to day. Now 48 years old and this, all the time this, and the rest of you. Yes very much very and very sudden. [00:07:37][43.1] Ron: [00:07:39] I understand that the hospital provided a number of classes to help prepare you for life with a new liver? [00:07:44][4.8] Gina: [00:07:44] Yes. You explained. Hospitals they go over everything that you need to do to prepare yourself before transplant and what you need to do. It was so it was terrible. At the time you're so sick that you can't even concentrate on what they're telling you. My caregiver was with me thank God because she took notes for me. During these meetings it's like a three day process where you meet different actors and different people on the team. Transplant team. It's very consuming. The information is very hard to understand because you're so sickly at the time. The toxins built up in my. In my brain. That. The liver. Isn't processing. And I became very confused and even I became combative. [00:08:33][48.9] Jean: [00:08:35] Did you realize that you were confused or combative?. [00:08:36][1.5] Gina: [00:08:37] No really. Well. When the nurse came in to check on me she asked me a couple of questions like What was my name and who was the president. What state do I live in. I answered. "Gina" To all the answers to all the questions. Yes. And. She knew from being a liver nurse she knew that was a symptom of toxins build up. In the brain. So immediately they put me to the emergency room and took care of me and they had to flush the toxins from my abdomen. [00:09:10][32.7] Lita: [00:09:12] Dangerous dangerous. You're from Chicago. But your transplant was in North Carolina. Why is that? [00:09:20][7.8] Gina: [00:09:20] Yes. Well I heard. They had some regions have faster results and you could register in more than one region. My caregiver told me about North Carolina because I was. Actually listed in Illinois where I live. For over a year. I only university. When she told me. About North Carolina and the turnaround in the. Past transplants. Turn around that they have their high. Low down and got on their list. And. High on their list. Actually in August of 2017 and I was transplanted. September 30th twenty seventeen. [00:09:55][34.6] Ron: [00:09:57] Definitely a lot there. What would you say was the worst part of this process. [00:10:02][5.1] Gina: [00:10:04] The worst part was waiting. Waiting. To. You know you don't know when you're going to get the phone call for the transplant. Getting sicker by the day. Ascities... The fluid retention in my stomach. Hurting. Constant swelling bloating. My legs were starting to give out because they were so swollen felt like my skin was going to rip open. There was nothing that they were prescribing me at that point that was helping me to get any kind of comfort. My sleep was lost. It was painful. Actually to even take a deep breath. Because the fluid was so. There was so much fluid in my stomach it was pushing the rest of my organs up. Through. My chest. And. Cause it Hard to breathe. [00:10:48][44.4] Jean: [00:10:49] It's sounds Awful. Did anything at all help with the swelling? [00:10:52][2.6] Gina: [00:10:52] . Well doctors told me to wear compression socks. Trying to stay positive thinking and moving about. Staying busy with my everyday life. The swelling in my stomach like I said before was released. Through. Paracentesis. That was the draining of the fluid. At the hospital. [00:11:12][20.0] Lita: [00:11:13] Sure. How did you feel when you first got that call saying. You know. We have a liver waiting for you. Was that was a surprise? Especially, you say it was only a month after you signed up over North Carolina! How did you how did that make you feel? [00:11:29][15.8] Gina: [00:11:30] Well I was shocked when I got the call I was actually at the store picking up. A prescription. And they told me to go home pack a bag and go to the hospital right away that they had a perfect liver. Well. I was excited. I was sad. I got very emotional I think every emotion went through me. When I got to the hospital. Yes I was excited but I had to wait for about. 10 hours before they actually operated on me. So I had time. For this information to sink in. Yeah. But it was at first it was a shock and I was. Like I went through every emotion. [00:12:05][35.4] Ron: [00:12:07] I understand you were released from the hospital sooner than some people, what do you think, what do you think about that? What aided you in your recovery? [00:12:16][9.4] Gina: [00:12:18] Well. I listened to my doctors I did everything they told me. Walking. Well actually let me back up. I'm sorry. I did. Exercise a lot before my transplant even though I was very sick. I had to try to build up muscle. They told me that after her transplant you would lose a lot of muscle. And I'm happy that I listened in that way because they after transplant you have to lock. And build up strength. But I'm glad that I was physically fit free for transplant. That makes sense. Also. I'm sorry but also eating healthy. As much as you can. You have to. Know a lot of protein low sodium a chicken and peanut butter nut protein bars protein shakes anything with high protein. That would build up muscle mass. [00:13:11][52.9] Jean: [00:13:12] Did you to take a lot of medication. [00:13:13][1.3] Gina: [00:13:15] After transplant? Yes I was on 40 pills a day, and it was four times a day. So yes when they, when the pharmacy rep brought in the pill box, the day before I got discharged, I said it looked like a fishing tackle box! (laughter from co-hosts) I thought to myself there's no way I would ever understand this! I'm not a pill person. And I just, I didn't think I could do it. But as time went on I, now fill up my pillbox blindfolded. (more laughter from co-hosts) Actually, I'm down to 16 pills a day so there is a big difference. [00:13:53][38.2] Ron: [00:13:54] Yeah. That's a lot to swallow. (co-hosts and guest laugh) Has anything changed since your procedure? [00:14:04][9.5] Gina: [00:14:05] Yes I mean I learned that I have to stay very active, walking is important. I wasn't able to lift anything five pounds or heavier. But now that I am six months out I am able to lift 25 pounds and more. I mean. I have to watch what I do because. They don't want me to get a hernia where the incision is. Absolutely there's no smoking no alcohol even sun exposure is considered high risk because of the medicine that I'm on can cause skin cancer. [00:14:37][32.4] Jean: [00:14:38] And just to keep an eye on your vitals. [00:14:41][2.1] Gina: [00:14:41] Yes every day I have to check my blood sugar because of the medicine intake could raise my blood sugar. I have to check my temperature. Make sure there's no type of fever. Virus going on I maintain a healthy diet. And again I do high protein and low sodium. [00:14:58][17.1] Jean: [00:14:59] Were there any rules, things that you cannot eat? Or is there anything that interferes with your medication? [00:15:05][5.5] Gina: [00:15:06] Yeah. The grapefruit you're not allowed to have any grapefruit or any product that has grapefruit in it. I was shocked to see that I I do. I used to use minced garlic in a jar and I found out that there's grapefruit juice in there some kind of preservative. And. Yeah. I was shocked. So you have to read every label. You have to make sure. The product is dated and if you can't read the day don't buy it don't chance it. If you. Touch something at the grocery store it is supposed to be cold and it's not. Don't buy it. Also. I would always use after transplant right after transplant when I was going to the stores or restaurants or out in the public I would wear face masks and I would bring wipes and wipe down everything handles of the grocery cart. Even menus at the restaurant. [00:15:53][47.0] Jean: [00:15:55] That's probably a good tip for everybody. Did anything make a recovery. Recovery period easier? [00:16:01][5.5] Gina: [00:16:01] While I was recovering at my house. I get it. Very great caregivers taking care of me. But also when I was by myself like taking a shower. I did use a grab bar in the shower. I did use the handlebars on the toilet seat. To get up and down because you are still sore. Compression sox would help my legs from getting to swollen. Squatty-Potty would help, so you don't have to, I'm sorry but, push while you go to the bathroom. You don't want anything. You don't want any tension around that. Incision. I also, like I said, the antibacterial wipes are very good. Use them Lysol spray. Wipe down everything. Just be cautious be careful. And you don't want to touch any germs. If you can't if you can rent a lift chair. [00:16:51][49.6] Lita: [00:16:53] Right. All of those products that you recommended like the squatty- potty and the handlebars for the toilet area. And the grab bars for the shower will be listed. On our Web site. For purchase. For anyone that's interested. And. The lady. Ready. Them back. Yes we'll be getting these products. From the Amazon Web site directly for you to show that you don't have to search too hard for these helpful aspects. You know there was good information. What would you. Like our audience to know about the importance of being an organ donor. [00:17:30][36.5] Gina: [00:17:31] Well I personally was never an organ donor myself but now I am. On Through. totally unknown it. I think everybody should be a donor if anything of ours can help. Two three. More people. I don't. Being a donor. I say. Definitely do it. [00:17:51][19.7] Ron: [00:17:52] That is an amazing story. Any other advice for the listeners out there. [00:17:57][5.1] Gina: [00:17:58] Oh yes I do actually. When you go to the doctor's office. Make sure that you. Tell them. Exactly. Your symptoms like if you. If you're feeling like you have a headache every other day or a sore throat once in a while just tell them everything that you feel or tell them. You are a drinker or tell them that you do diet pills or. Just. Be honest with them you're there for a reason you they're not going to judge you. And. Possibly they'll. Test you. And they'll before a disease. Occurs. They can help you. And treat you. [00:18:31][33.1] Jean: [00:18:31] That's great Gina, Thank you so much. Oh I want to thank you, on behalf of the podcast staff, and our listeners. And we really appreciate you taking the time today to speak with us. [00:18:41][9.9] Lita: [00:18:42] If you have any questions or comments related to today's show you can contact us at podcast D X at Yahoo dot com through our Web site where you can link to our Facebook page and also see more information as we build our site. Please go to podcast D X dot com. [00:19:01][19.3] Ron: [00:19:02] And if You have a moment. Please give us a five star review on the ITunes Podcast App.. [00:19:02][0.0] [1042.8]

Part 2 on Abdominal Paracentesis ! Let's go deeper Time Stamps Should a cirrhotic’s INR and platelets deter you from doing a paracentesis? (3:15) Do generalist have worse procedure complications than specialists?  (5:40) Do you need to send ascites fluid in blood culture bottles? (6:10) For full shownotes: https://www.coreimpodcast.com/2017/11/29/mind-the-gap-abdominal-paracentesis-2/

This week we dive into a recent journal article questioning whether we should tap all ascites. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_123_0_Final_Cut.m4a Download Leave a Comment Tags: Albumin, Cirrhosis, Paracentesis, SBP, Spontaneous Bacterial Peritonitis Show Notes Take Home Points SBP is a difficult diagnosis to make clinically. While patients may have the triad of fever, abdominal pain and increasing ascites, they are far more likely to only have 1 or 2 of these symptoms In patients admitted to the hospital with ascites, consider performing a diagnostic paracentesis on all patients as limited literature shows an association with decreased mortality and, the procedure is simple and low risk Once you get the fluid, focus on the cell count: WBC > 500 or PMN > 250 should prompt treatment with a 3rd generation cephalosporin and albumin infusion Gaetano et al. The benefit of paracentesis on hospitalized adults with cirrhosis and ascites. Journal of Gastroenterology and Hepatology 2016. PMID: 26642977 Read More EMRAP: C3 Live Paracentesis Video

This week we dive into a recent journal article questioning whether we should tap all ascites. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_123_0_Final_Cut.m4a Download Leave a Comment Tags: Albumin, Cirrhosis, Paracentesis, SBP, Spontaneous Bacterial Peritonitis Show Notes Take Home Points SBP is a difficult diagnosis to make clinically. While patients may have the triad of fever, abdominal pain and increasing ascites, they are far more likely to only have 1 or 2 of these symptoms In patients admitted to the hospital with ascites, consider performing a diagnostic paracentesis on all patients as limited literature shows an association with decreased mortality and, the procedure is simple and low risk Once you get the fluid, focus on the cell count: WBC > 500 or PMN > 250 should prompt treatment with a 3rd generation cephalosporin and albumin infusion Gaetano et al. The benefit of paracentesis on hospitalized adults with cirrhosis and ascites. Journal of Gastroenterology and Hepatology 2016. PMID: 26642977 Read More EMRAP: C3 Live Paracentesis Video

You have always been told to do a diagnostic paracentesis on admission in cirrhotics with ascites, but why? Can you just get away with clinical judgement to rule out SBP? Is faculty judgement any better? And if you’re going to do a paracentesis on admission, do you need to do it right away? Go deeper with Dr. Steve Liu and Dr. Janine Knudsen! Click the link for the full show notes: https://www.coreimpodcast.com/2017/11/01/mind-the-gap-admission-paracentesis/ Time Stamps What do guidelines say about diagnostic paracentesis in cirrhotics with ascites? (1:51) Can we just use clinical judgement to decide if paracentesis is warranted? (3:13) Do attendings have better clinical judgement than residents to rule out SBP? Does timing of paracentesis on admission matter for mortality? (6:33)

This video program is intended to provide a basic understanding of how to use the Safe-T-Centesis closed-system pigtail drainage device for thoracentesis and paracentesis procedures.

This video gives an overview of the Safe-T-Centesis Drainage System, a closed-system pigtail drainage device designed to help reduce the risks associated with paracentesis and thoracentesis.

Demonstration of technique for performing paracentesis.

Applications and procedural technique for diagnostic and therapeutic analysis of peritoneal fluid.

Applications and procedural technique for diagnostic and therapeutic analysis of peritoneal fluid.