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Clinical Lectures on Diseases of the Heart, Lungs and Pleura
Clinical Lectures on Diseases of the Heart Lungs and Pleura Author:Joseph McIntyre Patton Purchase of this book includes free trial access to www.million-books.com where you can read more than a million books for free. This is an OCR edition with typos. Excerpt from book: artery continues outward and downward in the sixth space. Rotch advises puncture in the fifth right interspace at the sternal border. Shattuck has made his most ... more »successful punctures just inside of the left lateral border of dullness from one to two inches outside of the nipple line. He strongly favors the apex of the left costo-xiphoid angle for puncture. At whichever point selected the instrument should be entered slowly and the vacuum turned on as soon as the needle is well engaged in the tissues, as the first intimation of the needle being in the sac may be the presence of fluid in the tube. There is no danger of removing too much fluid, but it is not wise to change the position of the needle point too often in hope of getting more. The removal of a small portion of a serous effusion will contribute greatly to the comfort of the patient and facilitate the absorption of the remaining fluid. My own preference in regard to the particular place to puncture is in the fifth interspace two inches from the left sternal border.' In some cases of large effusion I would be in favor of the costo-xiphoid space, though I have never tapped in this situation. For purulent effusions continuous siphonage is possible but more uncertain than in purulent pleurisy. Free incision of the pericardial sac with or with out drainage, should be made. The necessity of drainage will depend on the nature of the case; it does not appear to be necessary in all instances. Irrigation of the sac is not advisable except in selected cases. Porter has shown by dissections that the po'int for incision is in the fifth left interspace at the sternal border. The treatment of adherent pericardium resolves itself into maintaining the integrity of the heart, sustaining the general nutrition and teaching the pati...« less