Ugh. Eight weeks of medicine was exhausting. It both seemed like it took forever, and yet it wasn't nearly enough time to master everything for the mini-board (ya know, 'cause it's all of medicine). Good thing I will get a chance to catch my breath on my next rotation: surgery! Did I say catch my breath? I meant never sleep again! Ah well. Sorry for the super-crazy delayed catch-up post. I'd say that I will be returning to a more regular schedule, but... surgery.
TwoWeeksAgoIL: The common antibiotic bactrim increases the creatinine level (a common marker for kidney dysfunction) without damaging the kidneys. So don't panic about a patient's worsening renal status immediately after starting bactrim.
TwoThursdaysAgoIL: The wait time for liver transplants varies dramatically by region within the United States. In parts of the deep south, like Georgia, the wait time can be as little as a month and a half, but in New York or California, the same patient could be waiting seven to eight months.
A patient must have been ignorant to their alcohol problem to be approved for a liver transplant for alcohol-related liver failure. If they had already been warned about their drinking, and continued to drink anyways, then we can't trust them with a precious organ that they might voluntarily destroy again. Newly diagnosed alcoholics must go through a rigorous sobriety program to earn their new liver.
Quote of the Day: "To do the lobectomy, you essentially burn your way through the liver. I think of it as Sherman's march to the sea..."
TwoFridaysAgoIL: Pes anserinus bursitis is the painful irritation of the insertion of three upper leg muscles into the medial aspect of the tibia. The name "pes anserinus" literally translates from latin as "goose's foot" because of the shape of the three muscles joining looks like the toes (do birds have toes? [shrugs] somebody call a veterinarian!) of a goose.
TwoMondaysAgoIL: ...how to draw an ABG and, more importantly, how it feels as a patient to have an ABG drawn. My classmate and I decided to fill some downtime by stabbing each other!!! We had both drawn venous blood (which is the normal blood draw) and we had both seen ABGs (arterial blood gases) drawn, but neither of us had drawn ABGs before. Arterial blood draws are known to be substantially more painful than normal venous blood due to the beefier architecture of the vessels. We didn't want to practice this potentially painful technique on patients. So we borrowed some supplies and successively and successfully drew ABG samples from each other's forearms. It didn't hurt at all as it was being done, but then a steady deep ache set in afterward that stuck with me for a few hours. Not pleasant. I will never frivolously order that test.
TwoTuesdaysAgoIL: An idioventricular rhythm can look like a backwards Mobitz type II 2nd degree heart block. It amazes me sometimes that things like that don't sound like gibberish anymore. So, an idioventricular rhythm is a heart rhythm seen after heart surgery where the ventricles are beating on their own without the guidance of the atria. Totally opposite of the norm, the ventricles are actually beating faster than the atria. On EKG, this can look weird and result in the few "p-waves" from the atria creep closer and closer to the QRS complexes or the ventricles. In a Mobitz type II heart block, the p-waves progressively pull away from the QRS complexes.
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