Hapless Trainee

One side of the mouth will turn upwards, and the brow on the same side will turn down. It can definitely be seen in images of other people from this era, and also coincides with homes and spaces being increasingly lit with coal gas.

Symptoms of low-grade carbon monoxide poisoning can also manifest as feeling like you’re being haunted. Unease, visual and auditory hallucinations, all that. There have been instances of people today who think their house is haunted finding that they have something leaking CO into it instead.

I bet they’re also experiencing major depressive episodes in addition to the hypothyroidism (I won’t get into the details, but trust me, it’s highly likely), and this is a high number of severe cases in a short period of time (usually I’ll catch one mildly hypothyroid patient other month or so), but still

It was the first time something like that happened to me and honestly I had no idea how to react.

He was telling me how sorry he was for the things he did in the past and how lucky he felt now that he was with his daughter and two grandkids. He just wanted to get better but his prognosis is not good. He didn’t knew that and obviously I didn’t tell him.

This happened a week ago and I’m still thinking about it. Why, you might ask. Because I felt powerless, I wanted to help him but I knew I couldn’t, no one could.

The EMR (Electronic Medical Record) we use was updated over the weekend.  They didn’t tell us anything about the update other than we would have to delete all the templates from out list and use all new ones.  No details were given as to what was going to change on each template and which templates would have no replacement.  This update went as well as you think it did.

I’ve seen so many doctors use templates and put in the physical exam findings that were unusual but the template inserts everything else as normal. I know you didn’t do a heart and lung exam or check the patient’s reflexes because I was standing right there when you asked them three questions, pushed on their belly, and checked for edema so why are you putting it in their chart that you did? Because it’s in the template and going back to delete all the stuff you didn’t do would take more time than just signing it. Templates increase laziness and ensure errors. I’ve seen residents miss a hemoglobin of 6 because they just put their lab values dot phrase in, skimmed, and moved on to the next patient.

Electronics have sound

Appliances have sound

If electricity runs through it, it has sound.

Rarely is there actual silence (and that does bother me due to lack of sensory input).

This is why the barn uses me when they think the horses are reacting to a noise they can’t hear. I’ll likely find it (it’s usually the heating or the electrical box in the indoor).

Hyperkalaemia ECG changes in 15 seconds. 

High levels of potassium destabilise the cardiac membrane causing arrhythmia’s which lead to cardiac arrest. This can be a real life-saving opportunity if you can catch and treat it!

During surgery, the guts are rather quiet since we make patients not eat or drink anything for at least a day before abdominal surgery (NPO, or nil per oral diet). The consequence of this is, because the peristaltic movements of the guts are specifically in response to food, there’s no wriggling about, and thank god, because what if you cut one open by accident?

This reminds me of the other post on tumblr where there was a photo of someone with the entire proximal third of a very healthy looking femur mounted onto a walking stick with a caption claiming that it’s the OP’s father’s actual hip that was taken out during a hip replacement.

While the type of muscle present in our guts is very different than the kind of muscle in our arms and legs (the stuff we can control consciously), both rely on a chemical signal from something called acetylcholine in order to contract. No acetylcholine? No peristaltic squiggly eel movements.

In the kind of abdominal surgeries where people do rummage through a person’s bowels (like to find a place where there is obstruction or when they’re taking out a cancer, to make sure they don’t see any more), often a neuromuscular blocking agent is used to help relaxed the abdominal wall. These blocking agents mess with the ability of acetylcholine today stimulate contraction - that’s their goal! So, if a person is getting one, there’s a great chance their bowel won’t move a whole heck of a lot even if there’s no food in your guts for it to move.

For the medblr folks, as you may have guessed, the blocking agent I’m referring to is rocuronium and the other non-depolarizing agents. There is currently a study underway (registered in 2013) to evaluate the effect of roc on peristalsis, since, although it makes sense from a physiological perspective, there’s not published evidence to that effect at the moment! So, stay tuned.