One doctor's small effusion is another's nighmare
One day, when I was on a very busy hospitalist service, the ER called me with an admission. "I've got a 35 year old woman, shoots meth, smokes, uncontrolled diabetic, comes in with shortness of breath," the harried ER attending reported. "X-ray looks like a bilateral pneumonia, and some parapneumonic effusions too, but not enough to tap. Oh, and she's pregnant, about 14 weeks by LMP. She's stable but the last bed we have is in ICU, so that's where she's going.....
.........I examined her. She could only take shallow, mouse-like breaths and it looked as if she had to concentrate all her energy on mobilizing those breaths. I could barely hear any breath sounds at the bases of her lungs. I lost tactile fremitus in the middle of her left lung and heard egophony changes at the left base. When I palpated her belly, the top of her uterus rose well above her belly button, which suggested a gestational age over 20 weeks.
