A few months ago a rocket scientists from the ER admitted a patient for sepsis. Along the way, they attempted throwing in a subclavian central line. Needless to say, the patient ended up with a pneumothorax and a chest tube. The chest tube got dislodged and came out, so they jammed it back in. True story.
Looking back at the xrays, the subclavian entered into the skin almost right at the junction of the sternum and clavicle, very medial. Who the hell does that? Looking back through the ER chart, it turns out it was one of the "hotshot" ER residents who is cocky, overconfident, and a total ass. Figures.
What's more bizarre is that the patient wasn't even septic. They spit in his mouth, and his blood pressure came up. By "spit in his mouth", I mean they gave him a 250 mL bolus, the equivalent of adding one drop to the ocean. The blood pressure, according to the ER charting says the BP at it's lowest was 84 systolic. After that measly bolus it went up to 110. Sooooooooo septic!
In the ICU the patient was never even on a pressor! Go figure.
This irritates me to death. Be consistent. The truly septic patients never get a central line. They normal patients, get central lines.
ER residents and attendings need better training in central lines. I've put in over 2000 subclavians, and not once have I given anyone a pneumo. Why not get trained properly?
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