Chronic abdominal pain and nausea?
I'm taking care of an outpatient patient: 60y/o woman with chronic abdominal pain with prior history of gastric bypass, appendectomy, incisional hernia repair. Her pain had been previously controlled with oxycodone 10mg a couple times a day, but recently less effective due to emesis. GI is following now, has her on Zofran, Reglan, Promethazine but the nausea is still pretty severe. Patient is cachectic and having trouble with PO intake. Utox is appropriate.
I'm considering a Fentanyl patch...
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Source: Student Doctor Network - September 22, 2021 Category: Universities & Medical Training Authors: CarabinerSD Tags: Pain Medicine Source Type: forums
Another case
91 year old female, 88 lbs 4‘9, scheduled for umbilical hernia repair (1 cm or less), no known comorbidities. Patient is badly scoliotic. Her vitals and labs are all normal. What is you plan? (This is. A case I had today, pretty standard but it kinda went sideways midway trough). (Source: Student Doctor Network)
Source: Student Doctor Network - June 23, 2021 Category: Universities & Medical Training Authors: Sleeplessbordernights Tags: Anesthesiology Source Type: forums
Question regarding fluids and hemodynamics/case
Hello to the respected forum of anesthesia..
Had a case recently and I was thinking about it. Pt was 80 y.o. Male with preexisting HTN on ACE-I, mild dementia, overweight ( 100kg at around 1,80) and pertinent surgical Hx of repaired ing hernia 2 years prior. Had no bowel movement over 3 days and was posted for exlap for possible mechanical SBO. Labs were wnl, except Hb which was 9, Cr of 4.0, BUN of 100 ( prerenal AKI? )
On presentation he was in apparent distress, looking septic HR 110 in...
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Source: Student Doctor Network - May 20, 2021 Category: Universities & Medical Training Authors: CavGas Tags: Anesthesiology Source Type: forums
Rectus Sheath block
Anyone do these for umbilical hernia repair? I know that you are supposed to inject into the posterior fascia of the rectus abdominus. But it is a bit scary going that deep with the bowel right underneath. (Source: Student Doctor Network)
Source: Student Doctor Network - October 20, 2020 Category: Universities & Medical Training Authors: Sonny Crocket Tags: Anesthesiology Source Type: forums
Will medicine ever become boring ?
Ive shadowed lots of types of physicians, and it seems cool with all the variety but now that I realize as you chose a specialty it probably gets repetetive.
The gastric surgeon I shadowed was doing mainly hernia repairs and colon cancer excisions on a daily basis
Intervention cardiologist was pacemakers with a few other procedures but mainly pacemakers
Internal medicine was primarily dealing with checkups and physicals, in the hospital the standard stuff.
When you look at it as a whole...
Will medicine ever become boring ? (Source: Student Doctor Network)
Source: Student Doctor Network - September 25, 2017 Category: Universities & Medical Training Authors: CaptainJackSparrow83 Source Type: forums
Spinals for pediatric cases
Is anyone doing spinals for any peds cases? There was a talk at SPA 2016 about it (I missed it), so it seems like it's becoming more of a thing. I met one of my former residency attendings there who said he had started doing it for inguinal hernia repairs (on select cases). I'd like to look into it some more. (Source: Student Doctor Network)
Source: Student Doctor Network - August 9, 2017 Category: Universities & Medical Training Authors: twoliter Source Type: forums
Finding "the best" hernia repair surgeon
Background: I have a family friend with large bilateral inguinal hernias. His father suffered a similar predicament and ended up with 5 hernia repairs before ending up dying from CRC with a recurrent hernia on one side. In short, his father suffered extensively from his hernias despite going to what I would consider well trained, high volume surgeons in a major city. He has a brother with a history of hernias as well. My family friend has considerable wealth, resources and resolve...
Finding "the best" hernia repair surgeon (Source: Student Doctor Network)
Source: Student Doctor Network - June 24, 2017 Category: Universities & Medical Training Authors: mimelim Source Type: forums
Severe pulmonary hypertension for elective surgery.
Pt is 73yo M with severe pulm htn scheduled for hernia repair.
Pt has hx of COPD, CAD, and a-fib. Heart cath from a month ago shows pulmonary artery pressure in the 60s and about 60% stenosis of LAD that did not meet criteria for intervention. Echo showed nl LV EF, moderate TR, and severe pulm HTN. Pt can climb a flight of stair, but occasionally uses 2L O2 at home.
Pt went to see cardiologist prior to procedure, who wrote a note saying patient is at high risk for general anesthesia and...
Severe pulmonary hypertension for elective surgery. (Source: Student Doctor Network)
Source: Student Doctor Network - May 13, 2016 Category: Universities & Medical Training Authors: Chloroform4Life Source Type: forums
