Today I was in Ortho, because that's what I do, Ortho, Plastics and GYN and don't think I'm complaining about it.
The first patient was a healthy female 46 y/o 59.5 kg who injured her finger. She was a smoker, which affected her lungs obviously and made her more sensitive to the inhaled anesthetics we gave her. But being a smoker, her body is used to poisoning itself and she's less likely to throw up after surgery (speaking of throwing up, I'm two months into rotations and I haven't see anyone throw up...shrug), BUT she mentioned afterward that she remembered that the last time she had anesthesia she got a really bad migraine and she threw up, so they gave her some Demerol. Allergies: sulfa drugs and codiene...and I have no idea what that implies yet.
It's kinda weird how we're the same like that. Both of our bodies react with migraines when we think we're being poisoned. Anyway, back to the anesthesia. I gave her the 2 mg standard of Versed and she really liked it. 2nd time in a week I've had trouble with the BP. Dr. Lind wanted to start induction right away and I didn't get an initial reading because he was like stop it. Don't hit stop all, apparently it won't cycle anymore. We used lidocaine and propofol to induce. I left the Fentanyl in my chest pocket, I'm so used to people going in there, but Dr. Lind doesn't so she didn't get any until maybe 15 mins later. You could tell she needed it, her resperations were up and so was her HR. Oh, I put in an LMA, no problemo. But I'm used to standing around like, "yay, I did it, now I'll stare at it in admiration" when I should think:
1. connect the circuit so she's getting air
2. turn up the inhaled anesthetic
3. turn down the flows
4. put her on the vent (if ETT)
5. tape, tape, tape
She started moving a bit while the surgeons were washing her up so we gave her some more propofol (30 mg) and 50 mcg of Fentanyl. Then it was smooth sailing. We just gave her some Fentanyl when her HR went over 90 and then 4 of ondansetron about 10 before they started suturing. She woke up at about .2 eSevo with a start and I should have had a bite block because she was clamping down on the LMA...but she was pretty coherant. She told us about the Testical Festival in Nebraska :)
Second patient fell off (actually he admitted to walking of) a roof. Fractures to his hip, something else, and distal humerus. He was very helpful and nice but he smelled aweful, it was almost as bad as Sevo breath. He was 45 y/o 125 kg healthy except for the fall I think. Chaos was that his IV was tiny and didn't run well, so induction didn't go as fast as expected. We tried to do rapid sequence (no mask ventilation, hold cricoid pressure and stick the tube in) so we just used sux. I tried to intubate and he was all tensed up....but the time I got the blade under his tongue, his oxygen saturation dropped to 48% the lowest I've see yet, craziness! So we're like mask, mask, so we masked him at least to the high 80s-90s.
Then they were like go, intubate, and gave him more muscle relaxants which loosened his mouth up. I could barely see any vocal cords to go through. Why do all big guys have tiny vocal cords? But I saw the cartilage and I was like what the heck, I want to do this and if I don't get it right now his saturation is going to drop again, so I just went in blind. Luckily I got it in...thank God! So we tied it in and checked for breath sounds 4 times.
Patient breathing.....check
Patient alive.............check
Patient has no brain damage....pretty sure thats a check too
Then we needed a more reliable IV. Another freaking blind stick. I saw the bump that I assumed was vien, it was big and juicy, but I couldn't get it in. Why? Because my angle wasn't deep enough. Stupid me, obs when I can't see them I have to go a lot deeper. To add fuel to the drama, a mean nurse wouldn't let me stick the first patient because she was like well she only has one arm. I was so pissed off ...grrrr. It's my patient, MY IV...and its not like its my first freaking week! My instructor said she would yell at her for me :)
Today went by really fast....
Wednesday, July 29, 2009
Tuesday, December 2, 2008
The Mad Hatter
"The saying "Mad as a hatter" refers to the psychological deterioration of British hatmakers whose brains, was later discovered, were slowly poisoned as they moistened the brims of mercury-laden felt hats with their lips"
Myers Psychology in Modules 8th Edition
Friday, July 25, 2008
The Sugar Love Triangle
Food is a big deal. Everyone needs it and most everyone loves it. But food, namely sugar has a dark side. Thousands of people were enslaved, hundreds of thousands died, millions of people still suffer the consequences of the sugar high during the 1500s-1600s. Because our ancestors had a sweet tooth, today we deal with the fall out of slavery. Here's how the story goes...
Early in our history, sugar came from sugar cane. Sugar cane is kinda bamboo like and the process of extracting it is pretty complex. It was discovered in India, where the crusaders sampled the sugary goodness and brought it home.
The English (the Spanish too) fell in love with sugar and wanted to mass produce it. Tough luck for them, they didn't really have the warm tropical weather you need to grow sugar cane. India wasn't tropical enough and it produced to low a yield for the growing sugar market. On second thought, they had quite a bit of land in the New World. So they set out for the Caribbean and started sugar plantations.
Everything was going according to plan except that almost all their workers were dying of malaria and all those fun tropical diseases. Slaving away all day in the sun only to die of some exotic tropical disease was not exactly what the English (and Spanish too) signed up for. But the sweet tooth wouldn't go away. They needed cheap labor and tragically it was easy to find.
Tribal warfare in Africa resulted in the winning tribe selling off the loosing tribe (warriors, wives and children) to the highest bidder. The English had the perfect item to barter with: guns. Thus began the great sugar love triangle. Guns made in England were taken to Africa. The guns were loaded off and the slaves were loaded on. The slaves traveled across the ocean and dropped off in the "West Indies" where they worked on the sugar plantations. The boats picked up the sugar and sold it in England where they got gold and more guns.
The love triangle hit its breaking point when a brilliant German, Andreas Marggraf discovered how to extract sugar from sugar beats in 1747. Sugar beats are hardy, grow everywhere, and sugar is easily extracted from them. Sugar became easy to get, and coincidental with the sugar surplus, England abolished slavery in 1772. That's 25 short years for everyone keeping score at home.
The American War of Independence started three years later in 1775. When the great Constitution was adopted as law in 1787, it not once mentioned slavery. The logic is simple. The demand for slaves was being shot down by the sugar-beat extraction method. Very few new slaves were being brought from Africa, and people were generally pretty moral and set their slaves free. Our founding fathers created the greatest form of government, and made sure to address everything from religion to basic rights. It is no mistake they didn't address slavery. They assumed it would just die off, and they would have been right if it hadn't been for Eli Whitney.
1793, six years after the Constitution was approved, 21 years after England abolished slavery, and 46 years after the sugar beat method was invented Eli Whitney invented the cotton gin. Sadly, the slaves were already in the perfect cotton growing climate and the old sugar plantations just needed a tiny bit of remodeling.
So began the cotton plantation. Plantations, where slaves were treated as animals, led to the Civil War. Slaves were used as pawns to get the English and French on the side of the North. With slaves now bearing the guilt of the war, it lead to resentment of the Reconstruction, the KKK, and thousands of lynchings. Extreme racism occurred just one generation ago, and today we still hotly debate affirmative action.
Who knew that sugar would cause so much trouble.
Early in our history, sugar came from sugar cane. Sugar cane is kinda bamboo like and the process of extracting it is pretty complex. It was discovered in India, where the crusaders sampled the sugary goodness and brought it home.
The English (the Spanish too) fell in love with sugar and wanted to mass produce it. Tough luck for them, they didn't really have the warm tropical weather you need to grow sugar cane. India wasn't tropical enough and it produced to low a yield for the growing sugar market. On second thought, they had quite a bit of land in the New World. So they set out for the Caribbean and started sugar plantations.
Everything was going according to plan except that almost all their workers were dying of malaria and all those fun tropical diseases. Slaving away all day in the sun only to die of some exotic tropical disease was not exactly what the English (and Spanish too) signed up for. But the sweet tooth wouldn't go away. They needed cheap labor and tragically it was easy to find.
Tribal warfare in Africa resulted in the winning tribe selling off the loosing tribe (warriors, wives and children) to the highest bidder. The English had the perfect item to barter with: guns. Thus began the great sugar love triangle. Guns made in England were taken to Africa. The guns were loaded off and the slaves were loaded on. The slaves traveled across the ocean and dropped off in the "West Indies" where they worked on the sugar plantations. The boats picked up the sugar and sold it in England where they got gold and more guns.
The love triangle hit its breaking point when a brilliant German, Andreas Marggraf discovered how to extract sugar from sugar beats in 1747. Sugar beats are hardy, grow everywhere, and sugar is easily extracted from them. Sugar became easy to get, and coincidental with the sugar surplus, England abolished slavery in 1772. That's 25 short years for everyone keeping score at home.
The American War of Independence started three years later in 1775. When the great Constitution was adopted as law in 1787, it not once mentioned slavery. The logic is simple. The demand for slaves was being shot down by the sugar-beat extraction method. Very few new slaves were being brought from Africa, and people were generally pretty moral and set their slaves free. Our founding fathers created the greatest form of government, and made sure to address everything from religion to basic rights. It is no mistake they didn't address slavery. They assumed it would just die off, and they would have been right if it hadn't been for Eli Whitney.
1793, six years after the Constitution was approved, 21 years after England abolished slavery, and 46 years after the sugar beat method was invented Eli Whitney invented the cotton gin. Sadly, the slaves were already in the perfect cotton growing climate and the old sugar plantations just needed a tiny bit of remodeling.
So began the cotton plantation. Plantations, where slaves were treated as animals, led to the Civil War. Slaves were used as pawns to get the English and French on the side of the North. With slaves now bearing the guilt of the war, it lead to resentment of the Reconstruction, the KKK, and thousands of lynchings. Extreme racism occurred just one generation ago, and today we still hotly debate affirmative action.
Who knew that sugar would cause so much trouble.
Wednesday, January 30, 2008
Give me ideas!
With my classes being either hard core science (immunology and molecular neurobiology) or science dumbed down (nutrition) and history of college sports (which doesn't really fit the mood), I'm running into less inspirational ideas to write about. Plus my Wall Street Journal subscription ran out so there goes my weekly health update over lunch.
Therefore, questions and comments are requested. Please.... pretend that I'm begging.
Therefore, questions and comments are requested. Please.... pretend that I'm begging.
Food For Thought
According to my Nutrition class, osteoporosis may actually have nothing to do with the amount of calcium you take in, but with malfunctioning of hormones that control calcium removal and replacement in the bones. Bones, unlike teeth, are not solid structures. Well that's not what I mean. They are pretty sturdy, but calcium is continually taken from them or removed from them in order to keep blood calcium steady.
Steady blood calcium is more important than strong bones. Shocker, right! But without blood calcium, the nerves couldn't transmit electrical nervous impulses and such and muscles couldn't contract properly. So having strong bones and not being able to coordinate them is pretty much useless.
Anyway, because blood calcium is always steady, its hard to measure whether you have enough in your bones. It's not like you're gonna volunteer to have a biopsy done on your bones just to see how they're holding up. That's why hormone problems not diet problems is hard to prove.
A fact leaning toward the messed-up-hormones theory is that high intakes of calcium from supplements have been linked to kidney stones. The kidney, being the blood filter, gets overwhelmed with this massive amount of calcium, but your body can't incorporate it into the bones without the hormone signaling it to.
Conclusion? You could be screwed no matter how much milk you drink.
Solution? Eat everything in moderation, eat a variety of foods, and move your lazy butt at least once a week. Doesn't it seem that people living like this often end up living the longest?
Steady blood calcium is more important than strong bones. Shocker, right! But without blood calcium, the nerves couldn't transmit electrical nervous impulses and such and muscles couldn't contract properly. So having strong bones and not being able to coordinate them is pretty much useless.
Anyway, because blood calcium is always steady, its hard to measure whether you have enough in your bones. It's not like you're gonna volunteer to have a biopsy done on your bones just to see how they're holding up. That's why hormone problems not diet problems is hard to prove.
A fact leaning toward the messed-up-hormones theory is that high intakes of calcium from supplements have been linked to kidney stones. The kidney, being the blood filter, gets overwhelmed with this massive amount of calcium, but your body can't incorporate it into the bones without the hormone signaling it to.
Conclusion? You could be screwed no matter how much milk you drink.
Solution? Eat everything in moderation, eat a variety of foods, and move your lazy butt at least once a week. Doesn't it seem that people living like this often end up living the longest?
Thursday, December 20, 2007
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Wednesday, November 7, 2007
Shallow Thoughts
I haven't been posting because I'm still trying to balance school and life right now, but as I sat studying for my Medical Microbiology exam last night I felt incredibly pathetic.
My worst fear is getting herpes from sharing a friend's Starbucks or chapstick. Yes, I've said it before and I'll say it again. The thought of cold sores give me the chills. I think its the worst thing ever.
But people in Africa? Let me tell you about them. They're worst fear is Ebola; after getting infected you get a rash and bleeding out of your skin, as well as your nose and mouth.
Maybe I'm wrong and they fear polio. The last case in the US was in the 1970s, but in Africa you could end up with permanently damaged nerves and limbs that waste away over the years.
What if they fear Rift Vally Fever that leads to encephalitis (brain inflammation)? Do they know they're one mosquito bite away from malaria? Do they lie awake at night wondering if they could have HIV? Do they worry about passing it to their children, and leaving them orphaned as infants?
Honestly, I'm ashamed of my fear of herpes. How incredibly, amazingly blessed we are simply because we live on a wealthy continent. It's so easy to take it for granted when someone asks for a sip of my drink.
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