Notes to myself – 2
Pentobarb coma – BIS should be 10-20 and SR (suppression ratio) should be 70-80
Consider lev albuterol
Should give vaccines after coiling of spleen or before if possible
No calcium channel blockers post MI definitely and post op in general
Toradol inhibits spine healing
Don’t do endoscopes with patients in supine position
don’t ambulate patients with known dvt’s. wait 2-3 days until clots get stuck.
dvt’s even with filter get heparin as much as possible for post phlebitic syndrome and to retard new clot formation
diffuse alveolar hemorrhage – secondary to chemo, goodpasture’s, wege...
Source: Inside Surgery - December 31, 2013 Category: Surgeons Authors: Editor Tags: General Source Type: blogs
Some Joke
If you haven’t been threatened by a patient, you haven’t been working in an emergency department very long. It’s a common occurrence that shouldn’t be so common. You can read about “patients gone wild” on this blog almost every week – and those are just the incidences that make the news. Little threats come even more often than that.
Most of the time we just laugh the threats off.
One patient was a little more convincing than some of the others, though. It wasn’t just some idle threat. This overly intoxicated patient repeatedly yelled at the doc in a loud voice reminiscent of Yosemite Sam that “I’m goin...
Source: WhiteCoat's Call Room - October 30, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Patient Encounters Source Type: blogs
Medical Mispronunciations and Misspelled Words: The Definitive List.
Hearing medical mispronunciations and seeing misspelled words are an under appreciated joy of working in healthcare. Physicians often forget just how alien the language of medicine is to people who don't live it everyday. The best part about being a physician is not helping people recover from critical illness. The best part is not about listening and understanding with compassion and empathy. Nope, the best part about being a physician is hearing patients and other healthcare providers butcher the language of medicine and experiencing great entertainment in the process. Doctors c...
Source: The Happy Hospitalist - October 2, 2013 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous Source Type: blogs
An Amazing Experience in Nepal
By Heather Brown, MD
I had an amazing opportunity to spend a month working in the ED at Scheer Memorial Hospital in Banepa, Nepal, during my second year of residency. Scheer is a missionary hospital 30 kilometers outside Kathmandu with a six-bed emergency room open 24 hours a day. The ED was staffed with a mix of seasoned western physicians and young Nepali house staff who were mostly recent medical school graduates. There were plenty of chances to make a serious impact, and I was ready to do just that!
Arriving in Nepal
I’ve been passionate about international medicine since I was in college, and I cou...
Source: Going Global - September 12, 2013 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
An Amazing Experience in Nepal
By Heather Brown, MD
I had an amazing opportunity to spend a month working in the ED at Scheer Memorial Hospital in Banepa, Nepal, during my second year of residency. Scheer is a missionary hospital 30 kilometers outside Kathmandu with a six-bed emergency room open 24 hours a day. The ED was staffed with a mix of seasoned western physicians and young Nepali house staff who were mostly recent medical school graduates. There were plenty of chances to make a serious impact, and I was ready to do just that!
Arriving in Nepal
I’ve been passionate about international medicine since I was in college, and I couldn’t...
Source: Going Global - September 12, 2013 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Semantics
A 17 year old patient comes in by ambulance for chest pain and tachycardia. His heart rate was in the 130s. He was hypertensive. He was sweating. He had a history of ADHD and was on Adderall. No other medications. No alcohol or drugs.
His exam was unimpressive and all the testing came back negative, but the patient still remained tachycardic. So we gave him a couple doses of Ativan, thinking he may have taken a little too much Adderall. Still no better. Then we started doing some additional tests to rule out the less common reasons for his symptoms. D-dimer normal. He denied alcohol or drugs, but we checked for them anyway...
Source: WhiteCoat's Call Room - August 13, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Patient Encounters Source Type: blogs
5 Tips for Managing Anxiety During Transition
One of the primary characteristics of a Highly Sensitive Person (HSP) is difficulty processing change. The uncertainty of a new path generates anxiety, sometimes so crippling that the person is unable to move forward on the new path in front of her.
I am reminded of that this month as I make the significant transition from a job as a defense contractor — a communications advisor to a cloud computing company, with comfortable benefits — to an unstable gig as a freelance writer crafting pieces on mental health. I am following my heart all right, as it’s racing to catch up with me.
Every time I sit down to wri...
Source: World of Psychology - July 14, 2013 Category: Psychiatrists and Psychologists Authors: Therese J. Borchard Tags: Anxiety and Panic Brain and Behavior Disorders General Habits Mental Health and Wellness OCD Psychology Self-Help Stress Treatment Anxiety Panic Ativan Defense Contractor Depression And Anxiety Depression Anxiety Douglas Eb Source Type: blogs
Acupuncture & Chinese Herbs for Insomnia: It’s Working
In January 2013, I started my acupuncture and Chinese medicine experiment. I was seeking help with my chronic insomnia and willing to try anything.
After 11 sessions and a few different Chinese herbal prescriptions, I still could not figure out if the experiment was working. I felt confused and wasn’t sure if I wanted to continue.
In the end, money made the decision for me. I decided that if I couldn’t make up my mind, it didn’t make sense to continue paying for sessions and herbs.
At the same time, however, I was not ready to give up the experiment completely. I was still feeling desperate for regular sleep and ha...
Source: World of Psychology - July 7, 2013 Category: Psychiatrists and Psychologists Authors: Tracey Silver Tags: Alternative and Nutritional Supplements Anxiety and Panic Brain and Behavior Disorders General Mental Health and Wellness Psychology Self-Help Treatment Acupuncture Acupuncturist Address Ailments Chinese Herbs Chinese Medicine Source Type: blogs
Cases: What to do after the patient is made comfort measures only (CMO)
Discussion: Deciding to focus only on comfort is a major transition point for patients, families and health care providers. After making this decision, most families are not sure what comes next. They look to health care providers to reassure them that they are doing the right thing and to ensure that their loved one does not suffer and that they are prepared for the next few days. The following questions should guide one’s action after a patient is made CMO:
1. Are the patient’s symptoms adequately treated/prevented?
A standardized comfort measures only order sheet can optimize symptom m...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 8, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs
What to do after the patient is made comfort measures only (CMO)
Discussion: Deciding to focus only on comfort is a major transition point for patients, families and health care providers. After making this decision, most families are not sure what comes next. They look to health care providers to reassure them that they are doing the right thing and to ensure that their loved one does not suffer and that they are prepared for the next few days. The following questions should guide one’s action after a patient is made CMO:
1. Are the patient’s symptoms adequately treated/prevented?
A standardized comfort measures only order sheet can optimize symptom m...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 8, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs
Feeding tubes and weird ideas
My favorie BADD post: Tube-ageddon.
I haven't had much time to write anything here about the hell I went through getting my GJ tube. I had every indication for a GJ tube. I had gastroparesis so bad it was starting to affect my breathing, in a way that doctors said was likely to result in infection after infection until I died. From the emergency room onward, doctors were saying my best hope was to get a feeding tube.
Yet the pressure I got from doctors, while in the hospital for one of those infections, was to just keep getting infections, go home, wait to die. Most of them wouldn't say that outright. But so...
Source: Ballastexistenz - May 2, 2013 Category: Autism Authors: Amanda Tags: Abuse Autism Bullying Cognitive disability Degradation Developmental disability Disability Rights Discrimination Ethics Ethics, justice, etc. Food Hatred Medical Medical stuff Outside Perceptions Physical disability Power Source Type: blogs
That was a bad day!
I don't like needles. You might have heard this from me before. I was very clear with my oncologist when I was diagnosed that it was not an option for me to self inject. Ever. Last week I was told that my RA is not responding to oral treatment so I need to switch to injections. I was a bit stressed.I had no idea how stressed I was. Tuesday night I took an ativan so that I would be able to sleep and reduce some stress. Yesterday morning we had the teaching lesson with the nurse to learn how to self inject.I woke up with hives, a knot in my stomach, and extreme stress. Hives? That was a bit extreme. I have only had hives fro...
Source: Caroline's Breast Cancer Blog - April 25, 2013 Category: Cancer Tags: needles stress fear Source Type: blogs
Boston Bombing Suspect Sedated and Communicating
We continue to follow the reports of the medical care being given by Boston bombing suspect Dzhokhar Tsaranaev. The patient is reportedly intubated and sedated but able to communicate with investigators via writing.
CNN has a report that discusses this written in part by health reporter Elizabeth Cohen that uses quotes from several physicians commenting on the case. Unfortunately, these characterizations are inaccurate and wrong and were given by two physicians (Dr. Albert Wu and Dr. Corey Siegel) that obviously do not routinely sedate patients trauma patients in an ICU.
Only Dr. Athos Rassias of Dartmouth, who is Directo...
Source: Inside Surgery - April 22, 2013 Category: Surgeons Authors: Editor Tags: Musings Albert Wu bomb breathing communicating Corey Siegel ICU propofol Ramsey sedation suspect Tsarnaev Source Type: blogs
Playing Hooky
Yesterday I posted about my crappy week. It got even better. After working until 230, I rushed to a dr apt and then rushed home to a meeting that last until after 6, and then got THE call. 730am on Wednesday 4/24 we will get a lesson on delivering medication subcutaneously. What that means, they will expect me to stab myself with a needle. I will need an ativan for that.The news this morning is all about the shootouts overnight to track down the Marathon bombing suspects. One is dead, one is on the run, police officers are dead. These guys are armed and dangerous. The subway and bus system is shut down city wide. Some town...
Source: Caroline's Breast Cancer Blog - April 19, 2013 Category: Cancer Tags: hookey needles stress Source Type: blogs
