Showing posts with label medicine. Show all posts
Showing posts with label medicine. Show all posts
Gunshot wound to the shoulder
18 year old male with a gunshot wound to the Right shoulder.
He was casted and released without any severe sequela.
He was casted and released without any severe sequela.
Art at 3am
I was finishing rounds this morning when I came across this patient I had admitted earlier in the night for seizures. He drew this with a simple Bic pen that the hospital gives out for free.
A simple, cheap pen.
He gave me permission to take his picture with his artwork.
It was an honor to have him share it with me.
He gave me permission to take his picture with his artwork.
It was an honor to have him share it with me.
Drug deaths now outnumber traffic fatalities in U.S., data show
Fueling the surge are prescription pain and anxiety drugs that are potent, highly addictive and especially dangerous when combined with one another or with other drugs or alcohol.
http://www.latimes.com/news/local/la-me-drugs-epidemic-20110918,0,5517691.story
http://www.latimes.com/news/local/la-me-drugs-epidemic-20110918,0,5517691.story
Pneumonia
Severe pneumonia in an 88 year old ICU patient.
Note the diffuse haziness in all lung fields. This is easily one of the worst cases of pneumonia I've seen on x-ray.Unfortunately, the pt died 12 hours later. He had chosen a few years ago not to be placed on a ventillator if he was seriously ill, so we followed his wishes and provided comfort-care with all of his family at the bedside.
Have you ever thought about making an advanced directive to let others know about how you wish to be treated if something catastrophic were to happen?
http://www.caringinfo.org/stateaddownload/
"I really dont believe in doctors. I dont get flu shots. I believe in Jesus, and that He will keep everything of harm away."
-My new patient who came to see me for management of his blood pressure medicine. She has a blood pressure of 187/98. (healthy goal blood pressure for an adult=130/80). I guess Jesus doesn't protect against hypertension? I didn't bother to ask.
-My new patient who came to see me for management of his blood pressure medicine. She has a blood pressure of 187/98. (healthy goal blood pressure for an adult=130/80). I guess Jesus doesn't protect against hypertension? I didn't bother to ask.
Collapsed lung
I was called by the ICU nurse and told that this patient's oxygen had dropped suddenly. I ordered a STAT Chest X-Ray and it came back with a collapsed Left lung (actual X-ray below. Notice the arrows that are pointing to the outline of the lung. It's shriveled up and much smaller than it should be.)
Crashing Jets and Birthing Babies
I started OB today, and since the day was mostly spent filling out and receiving paperwork about the rotation, I haven't done much in the way of actual medicine. However, I did come across this really interesting nugget of wisdom from the OB textbook, page 1:
Maternal mortality has been an under-recognized issue worldwide despite an estimated 600,000 maternal deaths per year from pregnancy-related causes. Put in numeric perspective, this is equivalent to six jumbo jet crashes per day with the deaths of all 250 passengers on board, all of them women in the reproductive years of life.
Promotional Spending for Prescription Drugs
Yesterday the Congressional Budget Office released a brief highlighting trends in promotional spending for prescription drugs and market characteristics that influence promotional strategies.
The way that pharmaceutical manufacturers promote prescription drugs has changed significantly in the past decade. Up until the late 1990s, pharmaceutical manufacturers confined their marketing efforts largely to just doctors and other health care providers.
In the late 1990s, the Food and Drug Administration changed its advertising guidelines and drugmakers then began marketing directly to consumers—a practice known as direct-to-consumer (DTC) advertising.
Since then, the manufacturers of many prescription drugs have increased their purchases of air time on television and of advertising space in newspapers and magazines.
This year, drug companies are no longer allowed to give out pens, notepads, refrigerator magnets (just kidding about the magnets...kinda...), or any other kind of product that promotes their drug.
Many studies prove that that kind of "subliminal advertising" actually does persuade doctors to prescribe more of that particular drug, but I still say I wouldn't feel "guilted into" prescribing a drug just because I was given a free ink pen with that drug's name on it.
So basically I've waited all these years to be a doctor and get free pens, and now they've outlawed it!
The way that pharmaceutical manufacturers promote prescription drugs has changed significantly in the past decade. Up until the late 1990s, pharmaceutical manufacturers confined their marketing efforts largely to just doctors and other health care providers.
In the late 1990s, the Food and Drug Administration changed its advertising guidelines and drugmakers then began marketing directly to consumers—a practice known as direct-to-consumer (DTC) advertising.
Since then, the manufacturers of many prescription drugs have increased their purchases of air time on television and of advertising space in newspapers and magazines.
This year, drug companies are no longer allowed to give out pens, notepads, refrigerator magnets (just kidding about the magnets...kinda...), or any other kind of product that promotes their drug.
Many studies prove that that kind of "subliminal advertising" actually does persuade doctors to prescribe more of that particular drug, but I still say I wouldn't feel "guilted into" prescribing a drug just because I was given a free ink pen with that drug's name on it.
So basically I've waited all these years to be a doctor and get free pens, and now they've outlawed it!
Today in History: The Iron Lung
On this day in 1928, an iron lung medical ventilator, designed by Philip Drinker and colleagues at Children's Hospital, Boston, was used for the first time in the treatment of polio victims.
The 2 min. video below talks about a woman who has had to rely on an iron lung for over 50 years, after catching polio as a little girl.
So, Mark, just what is an Iron Lung?
An iron lung is a machine that enables a person to breathe when normal muscle control has been lost or the work of breathing is too much for the person to handle.
OK. Well, what is Polio?
Polio, caused by the RNA virus named Poliovirus, first enters the body through the mouth, infects a person's bloodstream, and then sneaks into the central nervous system by getting into the spinal cord.
[Read more about Poliovirus pathophysiology]
When the virus enters the nervous system, it damages the nerves that control your body's muscles, and thus it causes rapid paralysis.
Overall, 5–10% of patients with paralytic polio die due to the paralysis of muscles used for breathing.
How did the iron lung help polio patients?
Now it all starts coming together! As you now know, polio can cause your breathing muscles to be paralyzed, which would quickly lead to death.
With the iron lung, the patient lies within a sealed chamber and provides an effective oscillating atmospheric pressure. The pressure inside the machine goes up and down, just like the muscles in your chest cause the pressure in your lungs to go up and down, causing you to breathe.
An Iron Lung Ward filled with Polio patients, Rancho Los Amigos Hospital, California (1953)
The 2 min. video below talks about a woman who has had to rely on an iron lung for over 50 years, after catching polio as a little girl.
So, Mark, just what is an Iron Lung?
An iron lung is a machine that enables a person to breathe when normal muscle control has been lost or the work of breathing is too much for the person to handle.
OK. Well, what is Polio?
Polio, caused by the RNA virus named Poliovirus, first enters the body through the mouth, infects a person's bloodstream, and then sneaks into the central nervous system by getting into the spinal cord.
[Read more about Poliovirus pathophysiology]
When the virus enters the nervous system, it damages the nerves that control your body's muscles, and thus it causes rapid paralysis.
Overall, 5–10% of patients with paralytic polio die due to the paralysis of muscles used for breathing.
How did the iron lung help polio patients?
Now it all starts coming together! As you now know, polio can cause your breathing muscles to be paralyzed, which would quickly lead to death.
With the iron lung, the patient lies within a sealed chamber and provides an effective oscillating atmospheric pressure. The pressure inside the machine goes up and down, just like the muscles in your chest cause the pressure in your lungs to go up and down, causing you to breathe.
| Poliovirus |
|---|
 Electron micrograph of poliovirus virions. |
An Iron Lung Ward filled with Polio patients, Rancho Los Amigos Hospital, California (1953)
On Call
Tonight is my first "real" on-call night of my medical school career. I'm on the Pediatrics rotation for the next two months, and I have call every 5 days or so at the hospital.
I thought I'd let you follow me around...
(The next few posts might all be seperate ones until I can sit down another day this week and condense them all into one long "First On Call" post).
3 pm, Tuesday: Call officially begins.
4:34 pm: I'm told to head down to the Emergency Department to check on an 18 month old girl having asthma complications. When I get down there, she's already been given a breathing treatment and is looking much better! I interview the father (...by the way...I'm noticing a trend in Pediatrics that fathers often know FAR LESS about their babies than the mothers do!) who says he doesn't know how bad the girl was before the treatments because he just got to the ED to sit with the kid.
She seems to have improved a lot, but just to be cautious the Attending decides to admit the girl to our Pediatrics floor for overnight observation.
5:10 pm: Two hours into this and I'm already missing Heather, so I con her into meeting me for a quick dinner at Chipotle (cool website by the way).
5:40 pm: Back in the medical student lounge.
7 pm: A patient who has been in the hospital for 2 days because of Diabetic Ketoacidosis (due to lack of insulin production, which makes these kids have really, really high blood sugar) supposedly just ate dinner and now has a blood glucose of 430 mg/dL
That's really, really high.
[Normal should be anywhere from 80 to 120].
I go check on him and make sure he's not having any problems, and I explain to Mom that the high sugar is probably because he just ate dinner.
"I'll come back in a few hours to check on him again," I say, as I leave the room and head back upstairs.
9:08 pm: Headed to the newborn nursery to see if there are any new babies to examine and writeup.
Edit- no new babies.
10:33 pm: The OB/GYN resident informs me that they just delivered a baby. I'm headed down to the nursery to look over the chart and begin writing a Newborn Hospital Admission Note. Guidelines say that you should wait 4 hours to perform an exam on the baby, because their breathing, pulse, etc are still a bit crazy from the birthing process itself. If you wait about 4 hours, you'll be able to decide if the breathing, pulse, etc are normal or not.
12:30 am: Back in the student room. The new baby definitely has a working set of lungs. I wrote as much of the Admission Note as I could without examining the baby, and will go back down after 2am to do the physical exam and use the information gained from it to finish the Admission Note.
I guess it's time for a quick nap until then....
8am, Wednesday: Went to bed at 3am. Another baby was born at 3:05am. What luck. Now it's time to present my patients from last night to the Pediatric team at "Morning Rounds"
I thought I'd let you follow me around...
(The next few posts might all be seperate ones until I can sit down another day this week and condense them all into one long "First On Call" post).
3 pm, Tuesday: Call officially begins.
4:34 pm: I'm told to head down to the Emergency Department to check on an 18 month old girl having asthma complications. When I get down there, she's already been given a breathing treatment and is looking much better! I interview the father (...by the way...I'm noticing a trend in Pediatrics that fathers often know FAR LESS about their babies than the mothers do!) who says he doesn't know how bad the girl was before the treatments because he just got to the ED to sit with the kid.
She seems to have improved a lot, but just to be cautious the Attending decides to admit the girl to our Pediatrics floor for overnight observation.
5:10 pm: Two hours into this and I'm already missing Heather, so I con her into meeting me for a quick dinner at Chipotle (cool website by the way).
5:40 pm: Back in the medical student lounge.
7 pm: A patient who has been in the hospital for 2 days because of Diabetic Ketoacidosis (due to lack of insulin production, which makes these kids have really, really high blood sugar) supposedly just ate dinner and now has a blood glucose of 430 mg/dL
That's really, really high.
[Normal should be anywhere from 80 to 120].
I go check on him and make sure he's not having any problems, and I explain to Mom that the high sugar is probably because he just ate dinner.
"I'll come back in a few hours to check on him again," I say, as I leave the room and head back upstairs.
9:08 pm: Headed to the newborn nursery to see if there are any new babies to examine and writeup.
Edit- no new babies.
10:33 pm: The OB/GYN resident informs me that they just delivered a baby. I'm headed down to the nursery to look over the chart and begin writing a Newborn Hospital Admission Note. Guidelines say that you should wait 4 hours to perform an exam on the baby, because their breathing, pulse, etc are still a bit crazy from the birthing process itself. If you wait about 4 hours, you'll be able to decide if the breathing, pulse, etc are normal or not.
12:30 am: Back in the student room. The new baby definitely has a working set of lungs. I wrote as much of the Admission Note as I could without examining the baby, and will go back down after 2am to do the physical exam and use the information gained from it to finish the Admission Note.
I guess it's time for a quick nap until then....
8am, Wednesday: Went to bed at 3am. Another baby was born at 3:05am. What luck. Now it's time to present my patients from last night to the Pediatric team at "Morning Rounds"
Splashing
So it occured to me today that school has become like a nightmare swimming lesson. Picture yourself in the 12 ft. deep section of an olympic-size swimming pool. Now add the fact that the only preparation for this swim was that you recently aquired Floaties (but still haven't quite figured out the exact way to inflate and use them). At this point, you're either a sad 3 year old who has the remarkable ability to read blogs but is about to drown, or you are in medical school.
Being the later, I'll go on. So, you're in the middle lane and you are trying to make it down to the 3ft. section of the pool. Seems easy, right? Until your swim instructors start running along the side of the pool (where are the uptight, "No Running!"-lifeguards when you need them?) and throwing buckets of water at you. Yes, that's right, splashes out on you stealing what little breath of air you had; and, oh why not, the bucket itself hits you in the head too.
One after another, after another! They never stop! The next thing you know, the swim instructor is flying overhead in a National Forest Service Fire Helicopter and releases 500,000 gallons of water, knocking you 11ft back underwater again.
OK, so maybe it's not that bad. I know I'm complaining about something that I *willingly* pursued. But there really is no such thing as even being "caught up" these days. Every test hinges on the fact that if you just happen to miss one question too many..*just one question* more than the person next to you, there is a good chance that you're goin' home. The stakes are high, and the financial debt you're already in is higher.
I'm thinking medical school must be something like NAVY SEALs "for the rest of us."
Being the later, I'll go on. So, you're in the middle lane and you are trying to make it down to the 3ft. section of the pool. Seems easy, right? Until your swim instructors start running along the side of the pool (where are the uptight, "No Running!"-lifeguards when you need them?) and throwing buckets of water at you. Yes, that's right, splashes out on you stealing what little breath of air you had; and, oh why not, the bucket itself hits you in the head too.
One after another, after another! They never stop! The next thing you know, the swim instructor is flying overhead in a National Forest Service Fire Helicopter and releases 500,000 gallons of water, knocking you 11ft back underwater again.
OK, so maybe it's not that bad. I know I'm complaining about something that I *willingly* pursued. But there really is no such thing as even being "caught up" these days. Every test hinges on the fact that if you just happen to miss one question too many..*just one question* more than the person next to you, there is a good chance that you're goin' home. The stakes are high, and the financial debt you're already in is higher.
I'm thinking medical school must be something like NAVY SEALs "for the rest of us."
