You know the indication for Streptokinase installation in patients with pleural effusion/ empyema.

 Here is our routine.

Once indicated,

Streptokinase 250,000 units mixed with Normal saline in 50 ml syringe (total volume 50 ml)

put into chest tube

Flush with 50 ml of Normal saline.

We do it 12 hoursly for 3 days

and then review

if the patient need ?surgical intervention or not

Patients with continuing chest pain who are considered at high risk and would benefit from early coronary revascularisation should receive glycoprotein IIb/IIIa inhibitors. Those with the following features are at particularly high risk of infarction or death:

• Recurrent ischaemia (symptoms) – ongoing ischaemic chest pain

• Recurrent ischaemia (ECG changes) – ST-segment depression- T-wave inversion

• Troponin I elevated > 0.4 ng/ml

DKA guide line

About insertion of a central venous catheter

A central venous catheter, or central line, is a long hollow tube made of silicon rubber which is placed into one of the large veins in the body. One end of the line remains outside the body and can be used for injections. The other end is positioned inside a large vein, usually near to the heart. There are a number of veins into which the catheter can be placed; the most common being the axillary vein that lies just beneath the clavicle (collar bone) or the jugular vein that lies just above the clavicle at the base of the neck.

1.1 Treatment without valid consent is potentially an assault. In most cases gaining valid consent is straight forward, as most patients are clearly able to understand the information presented.

1.2 Where this is not the case, there is a problem because nobody else, not even the next of kin, can give consent on behalf of an adult who lacks capacity (this is different for children).

1.3 It is important that all doctors have a clear understanding of the relevant issues relating to Capacity to Consent to treatment and how to assess the patient’s capacity to make decisions, especially in respect of consent to treatment. If you have any concerns about your ability to adequately assess capacity to consent you must involve a senior colleague