Today was a pretty mellow review day. We got to sleep in a bit before attending morning conference. After that there was an hour long meeting on ICD-10, the new medical coding system that is very very slowly being adopted in the US. It was finished by the WHO in the early 1990s, but we've been dragging our feet on adoption in this country, in part because our lack of a national health care system means that the ICD-10 transition must be rolled out individually for every hospital, insurer, doctor's office, etc.
Our hospital uses one of the many terrible EMR systems fighting for dominance across the country and the unfortunate IT team is trying to update it with the ICD-10 coding system. This means trying to make it intuitive for health care providers, many of whom are not super tech-savvy, to sort through the 6-7 times more diagnostic codes that comes with this upgrade. I'm sure we'll get it all finalized by the time the WHO releases ICD-11 in 2018...
The rest of the day was mostly spent as a group going through an old oral exam (which, thankfully we don't do anymore) with the clerkship director. It was surprisingly helpful and a bit of a confidence booster going into our shelf exam on Friday.
TIL: There are very few reasons to do a classical vertical incision for a c-section. The horizontal incision is preferred for many reasons, including less damage to the uterine muscle, less potential for herniation after the procedure, and of course less visibility for aesthetic purposes. The older, vertical type of incision is slightly faster so, in emergent situations, vertical might be the way to go. It's also simpler, so if by some tragic circumstance the mother is dead but fetus is still viable, then there's no reason to make things complicated. If the woman already had a classical incision in the past, then it might make sense to do one again, but you wouldn't be faulted for doing a horizontal instead. Really, the last, best reason for a vertical incision is if the fetus is in one particularly bad orientation in the womb. If the baby is sideways with the back facing down (instead of the head or feet) then you won't have anything to pull on if you do a lower horizontal cut, so it's best to do a vertical instead.
A B-Lynch suture is a treatment for uterine atony where the doctor essentially ties the uterus into a ball with two big loops of suture thread. This artificially contracts the uterus (something it should be doing on its own after delivery) and stops postpartum bleeding.
Vanishing twins, when a pregnancy starts with two babies and one is reabsorbed, is becoming a more common finding simply because we are doing better ultrasounds, earlier in the pregnancy. Who knows; maybe you were a twin?
No comments:
Post a Comment