Medicine - Tumblr Posts
Thanks a lot!!!!
eEEYYYYY the studyblr community has some amazing note taking methods and so i wanted to put a bunch of them in one place :]
flashcards:
fc: cute language ones
fc: biochemistry paths
fc: disease summaries
fc: pretty biology ones
fc: the leitner methods
fc: ap us history ones
fc: o chem + color code
alternative 2 flashcards
sticky notes:
printing on sticky notes
take notes from textbook
plot summaries [literature]
many ways to use post its
english reading summaries
character maps 4 english
outlines:
color coded + neat
cornell + color code
digital cornell notes
learn from mistakes
super duper cute
outline with onenote
the margin method
in class / lectures:
for all classes + color
spaced out + pretty
for all classes / hw
advice @ infographic
2 notebook method
organized + colors
reference sidebar
method infographic
specific classes:
sciences + maths
history methods
learning types
sketchnotes:
introduction to it
cute symbols to use
+adorable symbols
+insp @ nice symbols
how to draw ribbon
illustrating ur notes
over the top amazing:
homemade textbook
digital study guides [1]
revision study guide
mini moleskine guide
digital study guides
handwritten studying
masterposts!!!
productive summers
starting a study blog
time managements
succeed @ school
ap world history
web resources
ap psychology
bullet journals
ace ur exams
stress reliefs
annotations
essay writin
printables
sat help
hope this helped u all with taking notes!!!!!! xoxo sareena
Hi! I just want to ask for some tips and advise I could use to survive as I become the lowest kind of species in the hospital barely a week from now. Thank you so much in advance! God bless you! :) I hope residency works smoothly for you. :)
Alright, Here are:
Dr. Dre’s Top 10 Tips for Excelling as a Third Year Medical Student
1. Be on time!
For Christ sake, be on time! Every time. It is the most simple thing you can do but that simple thing becomes excessively complicated when you sleep a MAXIMUM of 4 hours a night on your transplant surgery rotation. Set 10 alarms if you have to. Don’t let being late be something that shows up in your evaluation.
2. Always say YES! (to the dress)
I don’t care if it is a rectal exam, abscess drainage, fecal disimpaction, SAY YES! Your goal should be to try at least everything once. You don’t know you don’t enjoy prostate exams until you have done 10 of them. “No” is not in your vocabulary during third year.
3. Read up on your patients.
I prefer UpToDate, which I unfortunately have no stock in. Each patient presents an opportunity for learning. Try to read in real time after you have seen the patient, if there isn’t time, read that night. Not only will it help with your shelf exams but also impress those you work with.
4. Act like the specialty you are on is the one you are going to go into.
You are on urology, pretend to be the ext greatest urologist. You are on OB/GYN, you live and breathe OB/GYN. Getting into this mindset will: make you want to study more for that specialty, make residents and attendings want to show you more cool stuff and give you greater tasks, it will give you a true window into the specialty and if it is the right one for you.
5. Be upfront with your superiors “I want to do well on this rotation”
One of my best rotations, I started by telling the residents “Hey, I want to get honors on this rotation, let me know what I can do to get there.” Why be shy? What is wrong with wanting to do well. Let the residents know I wasn’t messing around. They challenged me and gave me constant feedback on my performance. Crushed it.
6. Let others know where you are going and when you will be back.
I hate hearing “Where is the medical student?” It is simple, tell the resident where you are going, how long you will be there and when you will be back. They can then tell you how to find the team when you return to prevent you aimlessly wandering the hospital halls. Or sending an annoying “Yo, where you all at?” page. I have heard from many colleagues who had evaluations read “Medical student was missing and unreliable.” Don’t let this be you.
7. If you don’t have enough to do help out with other residents patients.
On one of my easier rotations, I was so bored because my patients were not active. I wanted more to do. During rounds, I would listen to the “To Do’s” for the rest of our team’s patients and write them down. I would pick easy ones I could do quickly, Hey I can call speech language pathology for you, Oh I already looked at her urine bag, no blood.
8. Nurses can be your GREATEST asset.
Love them and respect them. They will really save your booty with your patients. They know more than you so listen to them!
9. NEVER EVER EVER ask if you can go home!
This right is reserved for second semester 4th year medical students. instead, always ask “Is there anything else I can do for you?” I know I know, you want to get home, eat, study, sleep but this is the way it goes. Some residents are cognizant of your needs and let you go. they remember what it felt like to be in your shoes. Yet, some are just plain mean. Making me check a patient for hypocalcemia symptoms at 8pm at night!
10. HAVE SOME FUN!!!!
Ok I don’t want to be cheesy but 3rd year is a whirlwind blast. THIS is what you have been waiting for, have been working towards. Patient care here you come. You get to pretty much play doctor. None of this sitting in lecture bullspit. People are going to start calling you doctor by accident and it is going to feel SO GOOD. Be a sponge and absorb as much as you can because everything is new and exciting. Relish these moments.
First Year of University: Medicine and what I Learned
First year has come to an end. It seems like yesterday I was sitting at my first lecture and, at the same time, it feels like a life time has passed. It was intense, hard, interesting, great and a whole bunch of mixed emotions as everything good in life is, right? It was a lot different then what I had expected, and I do not mean that as a bad thing. So here are a few things I learned this year.
1-When people say med school is hard, IT IS HARD!! We come from a place where we studied and worked a lot to make this dream come true, but the truth is, once we get there, it will be expected even more of us. It will be scary at first, actually it will continue to be, but that’s what makes you great, it makes you go beyond yourself, you discover that you were stronger and capable of pulling of stuff you’d never imagine. But you can do it, people before you did it and will continue to do it. You just have to give it your best, it takes everything you got.
2-You will fail. For the most of us, we will fail a couple of exams and even some subjects. The material is difficult, there’s no time to study, you might not have paid attention in lectures or not studied enough or studied the wrong way. The bottom line is, failing is not the end of the world. It is hard to find a doctor who has never failed at something throughout its life. And it’s important even to fail at somethings. It makes you humbler, it makes you work harder, it shows you what works and what does not, it will make you see how bad you want to be a doctor. I speak from experience and from what many doctors told us, one of the best doctors I know included. What is important is that, when you fail, you don’t go down. YOU FIGHT HARDER.
3-WE NEED EACH OTHER! I know that in many universities and medical schools competition is a constant in each med student’s life. I am really blessed that that is not the spirit in my university. We are a small university, there are few of us, but we are a united family that helps each other in times of difficulty that celebrates like crazy when things go right and that picks you up when things go wrong. The older ones guide the new ones and everyone helps each other out. And I can assure you it makes all the difference. Medicine is known at our university as the pack, we don’t fight each other to go the distance, we go together and we go further. That is our motto. You’ll meet very few people outside the medical profession that understand what you do, how hard it is and why you do it. Your colleagues do understand that, and that understanding should make them your family, your friends, not your enemy.
4- Don’t let examinations ruin the beauty of what you are learning. You are learning about one of the most complex and interesting subjects there is. What you learn will make the difference in people’s lives. Please, do not make it about a grade, because it is not.
5- Don’t miss out on life. Medicine will be a great part of your life. It is not a career choice, its life choice. But don’t miss out on a coffee with a friend, or a party here and there, get to know the people you work with, go out for a walk, go on fun adventures, and get to know the place you are studying in or show it to the ones who don’t know it.
6-Don’t waste time. Procrastination does not go well with medicine. Time is something that we don’t have too much to spare. Make the best you can with the time you have. Procrastination does nothing for you and the sooner you realise this the better. Ask yourself, “Do I really want to be doing this?” Do I really want to be watching this video? It’s not even funny, do I really need to take an hour to shower, when on any other time it would only take 20 minutes? Do I really need to be staring at that wall? Get that out of your way, you’re smarter than that and it will make you feel much better. Because, most of the time, you don’t ever want to be doing whatever you are doing as procrastination.
7-”when you’re tired, learn to rest, not to give up”. You’ve read it, you’ve memorized this. It is important
8-Treasure every moment. It will go by pretty fast. Treasure the things you learn, the friendships you make, the family you create, the teachers that truly inspired you, the walks around the campus, the adventures, the late nights with friends, studying or going out for fun, the crazy examinations with scary professors, those moments when you finally understand a difficult subject…. It’s your life, don’t pretend it isn’t. Make it extraordinary.
And now, Vacations!!! This blog revealed to be so much more interesting than I thought it would be, I met people from so many different parts of the world and talked about the most Random things. Thanks you for that. I hope you have a university experience as great as I had and am having. Never give up on your dreams. Keep fighting until the last second. Make every second count. See you next semester ;)
Video: Removing the Cerebral Hydatid Cyst!
Brain involvement with hydatid disease occurs in 1-2% of all Echinococcus granulosus infections (tapeworm infection). Cerebral hydatid cysts are usually supratentorial, whereas infratentorial lesions are quite rare.
Estudiar medicina no es difícil.
Ya me ha tocado escuchar a chicos de la facultad quejarse de lo “pesado” que es la carrera, por lo general son los de nuevo ingreso, aunque también me ha tocado la pregunta del millón: ¿Y está muy difícil la carrera?.
Lo cierto es que no. Medicina no es difícil, todo es cuestión de prioridades y organización. En estos últimos dos años he aprendido algunas cosas que hoy les comparto..
Seguir leyendo
Most bang-for-buck things every intern should know before starting inpatient wards
Source. A collection of Meddit resources and advice on what bread-and-butter topics interns would most benefit from brushing up on/memorizing prior to the beginning of their internship. 1) Fluids. How and when to use them, dosage, timing and other pearls.
Review of fluids (not how to use them per se) by Dr. Strong /u/ericstrong
Maintenance Intravenous Fluids in Acutely Ill Patients - NEJM.
Pretty thorough review of fluid management on openanesthesia.org
2) Nausea. When to treat, how to treat and at what dose.
3) Standard pn orders: pain killers, sleep aids and antiemetics aka how to reduce nighttime calls from nurses by 25%
4) “Reflex” antibiotic choice for routine inpatient infections.
http://www.bpac.org.nz/Supplement/2013/July/antibiotics-guide.aspx /u/ChristianM and /u/ive_been_up_allnight
5) Initial work-up and treatment of dyspnea. (more realistic to approach by symptoms as, unfortunately, you first have to diagnose whats wrong. E.g. heart failure, pulmonary edema, embolism, COPD, pneumonia).
6) Initial work-up and treatment of oliguria/anuria.
7) A sensible initial approach to suspected ileus.
8) Blood. When, how, why to replace.
9) Pain. Optimal management without inducing narcosis.
Managing cancer pain: Frequently asked questions: CCJM
10) Potassium. When, why and how to shift or replace.
A review on both potassium and sodium disorders by Dr. Strong /u/ericstrong (Not reposted in 12) hyponatremia but applies there as well) https://www.youtube.com/playlist?list=PLYojB5NEEakXVIAapcSEleP4doUdHVtld
11) Hyponatremia. Most common electrolyte disturbance, commonly mismanaged.
12) Resuscitation aka commit the ACLS algorithms to memory.
Current ACLS guidelines. https://www.acls.net/aclsalg.htm
Would love a video series, interactive cases etc.
13) Basic EKG interpretation.
Whole EKG video courses
A whole free youtube EKG video review course by meddit’s own u/ericstrong
An alternative EKG course that takes you through all the basics. This however has no free version and costs 96$ a year. The quality is amazing. Here are 6 basic sample videos on youtube. The paid course is available on http://www.ecgteacher.com/
I have to admit I haven’t used this course personally but his free youtube videos are on-point and he seems like a good teacher. Also behind paywall. Free youtube samples are here. The full course can be found here https://www.ecgacademy.com.
EKG video cases
Amazing case-of-the-week emergency medicine EKG videos on youtube by Dr. Amal Mattu
– If you like Dr. Mattu’s cases (and you most certainly will) he is still posting every single week on his new site https://ecgweekly.com. It costs 4 starbucks coffees a year and is going to save someones life.
Practice EKGs with answers
Watching videos isn’t enough, you still have to grind out EKGs to keep your game strong. Visit http://ecgmadesimple.com and http://ecg.bidmc.harvard.edu/maven/mavenmain.asp for this.
EKG blogs
I recommend signing up for some kind of RSS feed (e.g. https://feedly.com/) and subscribing to the following EKG blogs:
http://hqmeded-ecg.blogspot.is (Dr. Smiths ECG blog)
http://www.ems12lead.com
http://ecg-interpretation.blogspot.is
http://jhcedecg.blogspot.is
EKG resource libraries
Life in the fastlane has a nice resource to look up a specific EKG finding, criteria or concept.
http://www.practicalclinicalskills.com/ekg.aspx /u/collidge
14) Know when to order ABGs and how to interpret them.
Almost too detailed video lecture series on ABGs and how to interpret them by Dr. Eric Strong (/u/ericstrong)
Practice makes perfect. ABG interpretation generator. https://abg.ninja/abg
Bonus 15) Basic CXR interpretation
CXR video lecture course
Again, Dr. Eric Strong has an excellent video course for free on youtube
Step-by-step guides to basic CXR interpretation
The Radiology Assistant: Chest X-ray - Basic interpretation
Radiology Masterclass step-by-step basic CXR
University of Virginia’s step-by-step basic CXR
All inclusive resources
The art and science of thoracic imaging All inclusive resource for all things thoracic! Jokes aside amazing resource.
UPenns CXR learning website
Loyola Universities excellent CXR Atlas Most outdated look but amazing content.
Checklist approach to CXR
Bonus 16) Overnight o-shit-what’s-that Head CT interpretation
Midnight radiology: Emergency CT of the head
University of Virginia’s guide to the Head CT
Something almost forgotten from basic science. This information is very useful to understand why babies born before 24 weeks are very difficult to survive without extensive support. This is due to lack of surfacant and immature lungs. After 36 weeks, fetal lungs has matured. In practice, it is not absolutely necessary to supplement corticosteroid for fetal lung maturity to the mother after 34 weeks of gestation (although it is still acceptable to do so at 34-36 weeks).
Basic science rocks!
ABG Interpretation
Three Steps:
Normal ABG values:
pH: 7.35-7.45
For interpretation if pH normal: 7.4 is the cut off and above would be basic deviation and below would be acidic deviation
Carbon dioxide: 35-45 mm Hg
HCO3 (bicarbonate): 22-26 mEq/L
ROME: Respiratory= Opposite: - pH is high, PCO2 is down (Alkalosis). - pH is low, PCO2 is up (Acidosis). Metabolic= Equal: - pH is high, HCO3 is high (Alkalosis). - pH is low, HCO3 is low (Acidosis).
So you match up what the alteration is with the pH and that is the cause (say the pH is 7.36 (acidic end of normal) and CO2 is 50 (high, acidic) so that’s respiratory acidosis and if the HCO3 is 28 (high, basic) it is compensating so the blood gas is a fully compensated respiratory acidosis. If pH was not normal, its only partially compensated and if the HCO3 was normal it is uncompensated.
The chart below is what I use:
I hope this helps.
ICU Materials part 1
After 4 years of volunteering in the ICU of the local hospital for respiratory diseases I’ve finally started to really understand a lot of the diagnostic procedures and the meaning of their results.
So I’ve decided to share with you some of the materials I use to study the ICU Stuff:
ABG interpretation
https://abg.ninja/abg - The site gives you a results from ABG analysis and you have to make a reading of them, then it show you if you are correct or wrong and gives you a full description why. On this site there some other very nice medical quzzes as well - Glasgow coma scale, Cranial Nerves, Basic ECG etc.
Lung function tests
http://www.ums.ac.uk/umj080/080(2)084.pdf
http://www.ics.gencat.cat/3clics/guies/184/img/–americanfamilyphysician.pdf In these PDFs the basic aproach to spirometry is described, everything you need to know when you stumble across spirometry results.
Coagulation tests
http://thrombosiscanada.ca/wp-content/uploads/2013/08/Bloody_Easy_Coag_2013.pdf
http://www.pathology.vcu.edu/clinical/coag/Lab%20Hemostasis.pdf Very consise and well writen guidelines for coagulation tests interpretations.
Chest radiology
https://lane.stanford.edu/portals/cvicu/HCP_Respiratory-Pulmoanry_Tab_2/Chest_X-rays.pdf
http://www.southsudanmedicaljournal.com/assets/files/Journals/vol_1_iss_2_may_08/how%20to%20read%20a%20cxr.pdf Basic guidelines for reading a Chest X-ray
Echography - Ultrasound Imaging
http://www.sah.org.au/assets/files/PDFs/For%20Doctors/2011-crit-care-us-heart.pdf
http://www.cardioegypt.com/cardioeg/ACSCA2014-Presentations/002001.pdf
http://www.annalsofintensivecare.com/content/pdf/2110-5820-4-1.pdf
http://www.cardiovascularultrasound.com/content/pdf/1476-7120-12-25.pdf
http://www.ccforum.com/content/pdf/cc5668.pdf Very simple and easy to understand presentations for the newbies(like me) in Ultrasound imaging. To be continued…
ICU Materials part 1
After 4 years of volunteering in the ICU of the local hospital for respiratory diseases I’ve finally started to really understand a lot of the diagnostic procedures and the meaning of their results.
So I’ve decided to share with you some of the materials I use to study the ICU Stuff:
ABG interpretation
https://abg.ninja/abg - The site gives you a results from ABG analysis and you have to make a reading of them, then it show you if you are correct or wrong and gives you a full description why. On this site there some other very nice medical quzzes as well - Glasgow coma scale, Cranial Nerves, Basic ECG etc.
Lung function tests
http://www.ums.ac.uk/umj080/080(2)084.pdf
http://www.ics.gencat.cat/3clics/guies/184/img/–americanfamilyphysician.pdf In these PDFs the basic aproach to spirometry is described, everything you need to know when you stumble across spirometry results.
Coagulation tests
http://thrombosiscanada.ca/wp-content/uploads/2013/08/Bloody_Easy_Coag_2013.pdf
http://www.pathology.vcu.edu/clinical/coag/Lab%20Hemostasis.pdf Very consise and well writen guidelines for coagulation tests interpretations.
Chest radiology
https://lane.stanford.edu/portals/cvicu/HCP_Respiratory-Pulmoanry_Tab_2/Chest_X-rays.pdf
http://www.southsudanmedicaljournal.com/assets/files/Journals/vol_1_iss_2_may_08/how%20to%20read%20a%20cxr.pdf Basic guidelines for reading a Chest X-ray
Echography - Ultrasound Imaging
http://www.sah.org.au/assets/files/PDFs/For%20Doctors/2011-crit-care-us-heart.pdf
http://www.cardioegypt.com/cardioeg/ACSCA2014-Presentations/002001.pdf
http://www.annalsofintensivecare.com/content/pdf/2110-5820-4-1.pdf
http://www.cardiovascularultrasound.com/content/pdf/1476-7120-12-25.pdf
http://www.ccforum.com/content/pdf/cc5668.pdf Very simple and easy to understand presentations for the newbies(like me) in Ultrasound imaging. To be continued…
MEDICAL BOOKS
If you’re looking for some medical (non-textbook) books to read in your limited amount of spare time, check out some of my favorites below:
The House of God by Samuel Shem
A classic pre-medical school book. It details residency life in the 1970s. You can talk about this book with almost any medical student or attending. It is practically a medical school requirement.
Intern: A Doctor’s Initiation by Sandeep Jauhar
A more modern look into medicine residency intern year from the perspective of Cardiologist Dr. Sandeep Jauhar. Comes with the highs and lows you can expect. After having been through 6 months of residency, I would say it is very accurate.
Gifted Hands: The Ben Carson Story by Ben Carson. Just because I find Ben Carson incompetent as a politician does not mean I do not respect him as a doctor. He is a phenomenal pediatric neurosurgeon and this book details his story.
On Doctoring: Stories, Poems, Essays by Richard Reynolds
A book of stories and poems from doctors throughout time and also from famous poets and authors depicting their views of medicine.
Private Practice: In the Early Twentieth-Century Medical Office of Dr. Richard Cabot by Christopher Crenner
An interesting look into a Boston medicine clinic from the early 1900′s. With excerpts from old patient notes which I found very interesting.
And if you have an interest is something more dark:
Blind Eye by James B. Stewart
The real story of a doctor murderer from the 1990′s who killed multiple patients without getting caught for several years.
Devil in the White City by Erik Larson
The story of the World’s Fair in Chicago in the late 1800′s. A great look into the history of Chicago and the murderous doctor who roamed its streets.
And lastly:
The Hitchhiker’s Guide to the Galaxy by Douglas Adams. Just a great book in general. My favorite.
Suggested by other users:
The Making of a Woman Surgeon by Dr. Elizabeth Morgan
Suggested by http://thetay-in-the-757.tumblr.com
This book is my all time favorite, as I am a female aspiring to work in the healthcare system myself. Dr. Morgan chronicles her own journey in the male-dominated arena of medicine in the 1970s and 1980s, as she struggles to maintain an appropriate balance between remaining empathetic towards her patients and yet must toe the line of not becoming too emotionally involved with her patients so that she burns out, as well as maintaining her own femininity in a man’s world.
When Breath Become Air by Dr. Paul Kalanithi
Suggested by http://nandemokandemo.tumblr.com
When Breath Becomes Air is an autobiography written by an esteemed neurosurgeon who discovers he has Stage IV lung cancer in his final stages of residency. It appeals to not only medical students, with his profound impressions of cadaver dissection and his first life and deaths, but also to current medical professionals by questioning philosophical domains of mortality and what a meaningful life is, as well as to non-medical professionals with moving thoughts on family, life, death and meaning. It is not a novel to be missed by any person.
WHAT’S IN MY POCKETS?
Life as an emergency medicine intern can be pretty hectic, but having the right tools in your armamentarium can make things that much easier.
Here are some of the things I carry around on a day to day basis in the emergency department plus a few extras:
Stethoscope
Personally I carry the Littmann Cardiology III Stethoscope. It has served me well for about 4 years now. I think it has one of the best acoustic qualities for those not going into Cardiology. Plus it comes in black!
Stethoscope Hip Clip
White coats get dirty in he emergency department, I stick to just my scrubs mostly. I give my neck a break from hanging my stethoscope around it and clip it to my scrubs pants. Your future orthopedic surgeon thanks you.
Tarascon Adult Emergency Medicine Pocketbook
This book has saved my butt multiple times, especially as a 4th year medical student on Sub-Internship rotations. Faster than opening up your phone and waiting for your WikiEM app to update. Just flip to the back,f ind what your are looking for and BAM! It is especially useful on international rotations when you don’t have internet or data service to spare.
LED Penlight
I think pens with LED lights are less harsh on the patients’ eyes. These pens are still very bright so don’t directly shine them into the patients’ eyes just near them, unless you’re a jerk doctor.
Sanford Guide to Antimicrobial Therapy
A great deal of emergency department patients are discharged or admitted on antibiotic therapy. This helps you decide which drug for which bug without having to guess or remember back to your microbiology block. What if it is male with a UTI not a female? Or a kid with pneumonia? What common bugs need what drugs? This book helps a lot. Warning: paper cuts.
Trauma Scissors
Most trauma patients need their clothes removed. Those who are bleeding out and time is on the essence, whip out these babies and cut through almost anything. Be careful before they cut your dreams.
For yourself, medicine student.
Remember that you are not defined by a number. You are defined by what you have overcome and what you are enduring. A grade is not important, if you have not learned for your patients. You will treat people, not exams. Learn for them and study for them. They need the best out of you.
When and if you are tired, you are allowed to take a break, whether it be at 10 pm when you dont want to open that cardiology book, at 2 pm when class was difficult to understand or at 4 am when you are running tests on a patient. Take a moment to breathe, and go back to giving your all.
Do not compare yourself to other people or students, you are you and you are amazing. Do not diminish all that you do and all that you have done, because I have seen you work hard. Your only competition is yourself, you are working hard to become a better you.
Remember the reasons why you chose this path and why you started in the first place. I risk to say that beyond choosing this carreer because of the great challenge that it implied, you chose Medicine because of your desire to help another in need and your neverending fascination with the human body and its art.
Continue working slowly but steadily. Love what you do. Give your best always.
A Miracle of Love
For about 4 weeks, I rotated through the cardiac care unit (CCU) during my intern year of residency. Many would argue that the sickest patients in the hospital resided within the CCU. I came into the rotation hoping to perform several invasive procedures to further my skills as a young doctor. Patients could end up spending months in the hospital waiting for a new heart. While waiting, they were subjected to a litany of labs tests and interviews just to have the opportunity to be placed on the transplant list. Amidst the white walled hallways and vasoactive drips was a small woman in Room 503. Ms. S we will call her. Ms. S had been a resident of the CCU for about 3 months. She was a small, middle-aged woman with a heart that was growing weaker and weaker each day. Several days into my rotation, a heart became available for Ms. S. The entire CCU was a buzz with the news of a fresh heart awaiting transplant. It is rare in the emergency department when I am able to actually give good news to a patient. But I will never forget the look of Ms. S when she was informed by my supervising doctor that a new heart, one of the correct size and correct immune profile to provide the lowest chance of rejection, was available for her. The look expressed almost a bewilderment coupled with insurmountable joy.
While we were preparing for the upcoming surgery, the only request Ms. S had was for an in-hospital wedding to her longtime boyfriend. Faced with probably the most important surgery of her life, the patient’s mind was on something she waited her whole life for and if something were to go wrong with the surgery, she wanted to be united with the love of her life. And that union was not only with her boyfriend but also with her God facilitated by our hospital chaplain. Over the next week, my time in the hospital was consumed by caring for sick cardiac patients and planning a wedding. Paper flowers and EKG streamers strewed all over our call room. One day prior to the scheduled surgery, the patient was transported down to the hospital chapel. She was taken by wheelchair with her intra-aortic balloon pump, covered in colorful fabrics, towed behind her. The CCU staff sat on one side of the aisle while the patient’s family sat on the other side. The patient’s loud pump was briefly turned off during the ceremony. Afterwards, the staff and family held a reception in a room nearby with cake and refreshments.
During my medical school education, we were required to spend a day shadowing a hospital chaplain. The chaplain could be of any faith and my experience was with a Catholic priest. For those reading this who have never worked with a hospital chaplain, I highly recommend the experience. I can’t promise it will be a positive experience but it will certainly be memorable. I was under a misconception that a chaplain’s function was to comfort families when a patient was close to dying. Most patients we visited were not dying but were in the hospital for an “extended” stay. Religion was an important part of their life outside the hospital and they had few outlets of expressing their faith now that they were confined to a hospital bed. The priest would read the “Sacrament of the Sick” and say a healing prayer to comfort the patient and the family. I bowed my head during the prayer and gave the family space as they cried in the arms of the chaplain. My most memorable experience took place in the room of a newborn child. The child was too sick to go home and the family requested an impromptu baptism. I, personally, had never been a part of a hospital baptism. I was elected videographer for the event and was excited at the thought of new life in the hospital vs the death and dying I expected when the day began.
In the hospital at which I work, each cardiac arrest that is called overhead will automatically send a page to several other services. One service I always see respond is the chaplain service. This service is invaluable when it comes to consoling family after a loved one has passed away. No matter which denomination they are called for they are always willing to bring together family when they encounter an unexpected situation in the hospital. As doctors, we encounter bad outcomes on a regular basis and are expected to pick ourselves up and return to work as if nothing happened. We set aside time to inform the family of what has happened but the chaplain is able to offer more comfort by just “being there.”
As a whole, doctors are not viewed as an overtly religious species. We are viewed as pragmatic, calculating and data-driven. But medicine and religion are not mutually exclusive. When those who tell stories of witnessed miracles often cite a hospital setting. A sick family member who is close to death and has exhausted all of medicine’s resources. Then, with family’s prayers and faith, the patient will make a recovery. Some will say they have experienced a miracle, something intangible and not explained by objective data. I have seen many sick patients pass through my hospital, though it may seem like a small amount compared to a more experienced doctor. I’m not sure what my definition of a miracle would be but I think all those who have experienced a miracle would agree that you know when you are in the presence of one. Looking back at this experience, a hospital wedding prior to a heart transplant surgery, I may never have this experience again. I can now say I have experienced a miracle, a miracle of love in our hospital.
“Being deeply loved by someone gives you strength, while loving someone deeply gives you courage.”
-Lao Tzu
Emphysema
Chronic obstructive pulmonary disease (COPD) is an umbrella term à emphysema, chronic bronchitis, certain types of bronchiectasis, and sometimes asthma. COPD = leading causes of death in the US - appears to be rising.
SYMPTOMS
Persistent cough + wheezing + sputum production
Tightness or pain in the chest + shortness of breath
(when progressed) Loss of appetite
Depression
Reduced sexual function
Trouble sleeping
Long term smoking is the leading cause of emphysema. Other risk factors include a deficiency of enzyme alpha-1-antitrypsin, air pollution, airway reactivity, heredity, male sex, and age.Most people with emphysema also have chronic bronchitis (inflammation of bronchi)
Hallmarks of Emphysema
“pursed-lipbreathing.” The person with emphysema struggles to exhale completely, in an attempt to empty trapped air. They purse their lips, leaving only a small opening. Then, when they exhale, the lips block the flow of air, increasing pressure in the collapsed airways, and opening them, allowing the trapped air to empty.
“barrel chest,” where the distance from the chest to the back, which is normally less than the distance side to side, becomes more pronounced. This is a direct result of air becoming trapped behind obstructed airways.
Mechanism
causes shortness of breath due to over-inflation of the alveoli
the lung tissue around small bronchioles is destroyed/impaired making them unable to hold their shape during exhalation - making it difficult for the lungs to empty and the air becomes trapped in the alveoli.
Normal lung tissue looks like a new sponge. Emphysematous lung looks like an old used sponge, with large holes and a dramatic loss of “springy-ness” or elasticity.
An abnormal and permanent enlargement of air spaces distal to the terminal bronchioles
also severely affects capillaries + blood flow
Cigarette smoke (and other smoke inhalation including dust and air pollution)
Destroys lung tissue, which results in the obstruction of airflow, and it causes inflammation and irritation of airways that can add to airflow obstruction.
Cigarette smoke causes dysfunction of the cilia.
Long-term = cilia disappear from the cells lining the air passages. Without the constant sweeping motion of the cilia, mucous secretions cannot be cleared from the lower respiratory tract.
Smoke causes mucous secretion increase – coupled with above causes mucous build up
providing bacteria with a rich source of food –> infection.
Smoking and the immune response
Lung immune cells cannot clear many particles (such as tar) that cigarette smoke contains.
Increase in susceptibility to lung infection
Inflammation caused by the immune system constantly attacking bacteria or tar from smoking leads to the release of destructive enzymes from the immune cells.
Over time, enzymes released during this persistent inflammation lead to the loss of proteins responsible for keeping the lungs elastic.
In addition, the tissue separating the air cells (alveoli) from one another also is destroyed.
Tests
Chest X-Ray – changes in lung are physical and visible. Can also show infections.
Lung function tests (how much air your lungs can hold, how quickly your lungs can expel air during expiration, and how much reserve capacity your lungs have for increased demand)
Blood test for alpha-1-antitrypsin deficiency – only if family history.
Blood tests for WBC count for infection
Arterial blood gas test (O2 + CO2 levels)
Treatment
Emphysema causes irreversible damage - treatment can only slow progression
Stop smoking: halt progression and should improve lung function
Bronchodilators: cause the air passages to open more fully and allow better air exchange, usually the first medications for emphysema - mild cases eg = albuterol (taken with inhaler), fast acting and 1 dose provides relief for 4-6 hours – is a relief medication for periods of shortness of breath, but doesn’t cure. Tiotropium = long acting, more severe. Taken once a day and can extend life expectancy
Steroid medications: decrease inflammation, however not all people will respond to steroid therapy. Orally or inhaled.
Surgery if severe eg lung transplant
