Encyclopaedia Azaria #5: The Noble Houses of Azaria

A new month, and a new encyclopaedia entry! This time Eliza and Lady Navinka take a look at the background of the remaining noble families of Azaria...

Stock credit:
Background: Fire Emblem: Radiant Dawn sprite background
Noble House heraldry art: http://www.heraldicclipart.com/catalog/index.html

Encyclopaedia Azaria #1: The Iasometer

Encyclopaedia Azaria #2: The Tale of the Binding

Encyclopaedia Azaria #3: The Gladier-Farrontine Feud

Encyclopaedia Azaria #4: The Binding Spell

Encyclopaedia Azaria #6: The Goddess Shrines

Read an Ebook Week- free copies of The Binding!

As part of Read an Ebook week, I'm putting The Binding up for promotion. Grab the ebook for free, using the following code: RW100

The offer ends 08/03/2014, so get it quick!

Top 5 Most Painful Medical Procedures

Alright, so anybody who's ever been admitted to hospital or needed a specialist medical investigation will have met with their fair share of uncomfortable procedures, whether it's blood tests or certain examinations. Some of course are more painful than others, particularly where needles are involved, so this is a list (in no particular order) of some of the most feared medical procedures carried out on patients.

Having often been the one doing and not receiving these tests, I also don't have much of a personal connection to these tests, hence why it's not a hierarchical list.

But trust me, it hurts me more than you :P

1. The arterial blood gas. (ABG)

Source

One of the most useful and acute bedside tests available in modern hospitals today, the arterial blood gas, fondly abbreviated to ABG, has long been considered a fairly painful procedure. Although it's quick, the site of the test (often the radial artery at the wrist) and the angle in which the needle must strike the skin can be very off putting to patients, and it's often described as more painful than a regular blood test (venepuncture).

Why it's done: to check blood acid/base balance, oxygen and carbon dioxide levels, and other useful items like lactate and estimations of haemoglobin and electrolytes. The test is essential for lung or heart conditions or if there is severe organ failure, or if a patient is acutely unwell and there is no clear cause. It also gives an indication of severity of illness, and can be repeated to see if a treatment is working.

Further reading: http://healthlibrary.epnet.com/GetContent.aspx?token=c5987b1e-add7-403a-b817-b3efe6109265&chunkiid=14767

2. Bone marrow aspiration and trephine/ biopsy

Source

Though not that common a test, this is arguably THE most painful invasive investigation. In general solid organ biopsies aren't very comfortable, but the bone marrow aspiration is in a league of its own. This is where a direct tissue sampling of the bone marrow is performed on a conscious patient. Although this procedure does involve local anaesthetic, this is only injected on the superficial skin, and since bone is richly innervated it's very sensitive to large needles coming through and scraping out some marrow. For some patients it's too much, and it has to be done under a general anaesthetic, though this isn't common.

Why it's done: to investigate any bone marrow disorder, ranging from the leukaemias and lymphomas to the bone marrow diseases such as myelofibrosis.

Further reading: http://healthlibrary.epnet.com/GetContent.aspx?token=c5987b1e-add7-403a-b817-b3efe6109265&chunkiid=14757

3. Lumbar puncture (CSF tap)

Source

A lumbar puncture is where a spinal needle is inserted into the cerebrospinal space and the fluid here (cerebrospinal fluid, CSF) is tapped and sent for various investigations, including estimation of glucose and protein, looking under the microscope, and culturing to grow bugs. A special test also looks for something called xathochromia, which is indicative of an acute bleed within the brain. Again, while local anaesthesia is used for the skin, it can still be discomforting.

Why it's done: to look for nervous system disease, from acute problems like meningitis or subarachnoid haemorrhage, to other infections like tuberculosis, or for other diseases such as multiple scelrosis.

Further reading: http://healthlibrary.epnet.com/GetContent.aspx?token=c5987b1e-add7-403a-b817-b3efe6109265&chunkiid=14865

4. Colonoscopy

Source

A small bore camera is inserted via the back passage and allow for direct visualization, biopsy sampling and even treatment of diseases affected the large bowel. However, it does require a lot of preparation (the bowel needs to be 'purged' to allow for a good view, usually done two days prior with potent laxatives and a clear diet), and can be very discomforting as air needs to be inflated into the bowel. Some patients find the procedure intolerable after a certain distance in the bowel, and so the procedure has to be abandoned.

Why it's done: to check for bowel problems ranging from bowel cancer, inflammatory bowel disease, polyps, diverticulosis and many others. Samples can also be taken to be looked at under the microscope (histology), and polyps can even be removed at the same time as well.

Further reading: http://healthlibrary.epnet.com/GetContent.aspx?token=c5987b1e-add7-403a-b817-b3efe6109265&chunkiid=14795

5. Transoesophageal echocardiography

Source

Most people are familiar with ultrasound and the typical echocardiogram- a scan that looks at the heart- done via the chest wall (transthoracic). However, the scan can also be performed from the inside via the oesophagus (gullet), which allows for better views of other chambers. Similar to having an upper GI endoscopy (camera test looking at the stomach and upper intestines), an echo probe is placed down the mouth, via the throat, and the heart imaged in the chest. Sedation can be given and local anaesthetic spray to the back of the throat, but it can still cause a lot of discomfort to some patients.

Why it's done: to check the chambers of the heart, heart wall thickness and chamber size, function of the valves, how much blood the heart pumps, and if there are any blood clots sitting in the heart.

Further reading: http://healthlibrary.epnet.com/GetContent.aspx?token=c5987b1e-add7-403a-b817-b3efe6109265&chunkiid=191606

There are probably loads more tests I've skipped over, but these are the ones that stick out for me. What test have you had done that's made you cringe?