HoldStillItWontHurt

P R O D U C T I V I T Y

30/30*  - personal favorite, I always use this to study and manage time.

Essential productivity apps for any student*

Top 5 productivity apps for iOS (video)*

Top 5 productivity apps for Android (video)*

StayFocusd*- limits the time you can spend on time-wasting websites

Time Warp* - keeps you from procrastinating 

Self Control* - blocks websites

The science of productivity (video)

The science of procrastination and how to manage it (video)

7 brain hacks to improve your productivity (video)

The simple science of getting more done (in less time)

Productivity tips

About power naps

How to pull an all-nighter effectively

O R G A N I Z A T I O N 

My Study Life* - It’s a planner to help you remember when your homework is due and stuff like that

Free printable planner

To do list

How to make a study schedule

Class folder organization 

S C H O O L // S T U D Y I N G

Inkflow Visual Notebook* - I haven’t used this one, but it’s for note taking (if you’re a visual learner it’s probably quite useful

Free Flashcards Study Helper* - Create flashcards and carry them around to study anywhere

Apps for students*

Tips and trick to help you get good grades

Learning how to study

Cornell note taking method

BBC Bitesize

Studyblue - flashcards, quizzes, review sheets, study guides, etc.

Essay writing

Textbook masterpost (and other stuff too)

Wolfram Alpha for research 

Memorizing dates

Making a good study guide

Note taking like a pro

Online calculator

Finals survival guide

How to survive finals

School survival guide

Free online courses

Scholarpedia

Mathway

Khan academy

Quizlet

Homework help

Exam survival tips

Studying for an important exam

Answering multiple choice questions

Guide on punctuation

Science simplified 

How to answer exam questions

How to study

Useful websites

CrashCourse

How to write an essay

Duolingo

P R  O J E C T S

Public speaking

Annoying Power Point presentation mistakes

Power Point presentations

Prezi

Emaze - similar to prezi

Rawshorts - video presentations

Hypoplastic Left Heart Syndrome (HLHS)

HLHS is exactly what it sounds like: the left sided structures of the heart are hypoplastic or underdeveloped. While the exact features can vary between patients (HLHS variants), typically HLHS describes 6 defects. 

Mitral valve atresia

Severe aortic valve stenosis

Hypoplastic left ventricle 

Atrial septal defect (ASD)

Hypoplastic ascending aorta

Patent ductus arteriosus (PDA)

Mitral valve atresia. The mitral valve allows blood between the left atrium and the left ventricle. In atresia, the mitral valve does not open. Blood cannot enter the left ventricle, causing the left ventricle to become severely underdeveloped. 

Severe aortic valve stenosis. The aortic valve allows blood into the aorta from the left ventricle. Stenosis means the valve does not open completely. This (combined with mitral valve atresia and left ventricular hypoplasia), means blood cannot enter the aorta where it normally does. Instead, it bypasses the ascending aorta and enters near the aortic arch through the PDA. This decreased blood flow causes the ascending aorta to become severely underdeveloped. 

Hypoplastic left ventricle. Normally, the left ventricle is the strongest in the heart. It pumps blood out through the aorta into the body (systemic circulation). When the ventricle become hypoplastic, it cannot adequately supply the body with oxygenated blood. This is why HLHS is referred to as a single ventricle defect: the right ventricle is the only effective pumping chamber in the heart.

Atrial septal defect. An atrial septal defect is a hole between the atria of the heart. This allows blood to be shunted between them, bypassing the left ventricle and entering the right ventricle. The right ventricle is now responsible for pumping blood to both the body and the lungs. As you might expect, this causes oxygenated and deoxygenated blood to become mixed together. 

Hypoplastic ascending aorta. Because the ascending aorta is underdeveloped, the surgery for HLHS involves constructing a new aorta from the base of the pulmonary artery (one step of the Norwood procedure, the initial surgery for HLHS). 

Patent ductus arteriosus. This isn’t technically a defect, as all babies normally have a PDA that closes shortly after birth. I feel it’s worth noting, though, as the PDA will need to be kept open in babies with HLHS. The PDA is a connection between the pulmonary artery and aorta. When blood is pumped from the right ventricle into the pulmonary artery, the PDA allows some of it to flow into the aorta as well. This is the only way blood is able to enter systemic circulation. Life is dependent upon the PDA in this defect, and prostaglandin must be infused to keep it open until surgery can be performed.

I was assigned to a new admit early last week.

69 yo WF from nursing home, CC abdominal pain, tenderness, distension a/w thin brown emesis and constipation for two weeks, comorbid w/ CAD, MI x1 + CABG, HTN, CKD Stage III or IV, T2DM and L BKA. I was initially thinking massive bowel impaction 2/2 diabetic gastroparesis plus opiate-related slowing of bowel traffic.

Sure, we did find a ton of bowel impaction.

I’m on nights in the ED, and last night was an intense shift. 

My first patient of the evening was a woman who was sent to the ED by her PCP for an indicentally-discovered WBC count of over 200, with 8% blasts (immature cells). That, non-medblrs, is very high, and she came in the door already understanding that she almost certainly had leukemia. I sat down with her and explained the next steps, and gave her The Talk that I have started to routinely give to people with new, serious diagnoses. The Talk goes roughly like this:

“A lot of things are about to happen in a pretty short amount of time. There will be a lot of people helping to take care of you. It might feel invasive and overwhelming, but I want you to know that you are the driver. If you are confused, ask questions. If something is happening that you don’t like, you can tell us to stop. This is your body and you always get to decide what happens to it. As doctors we sometimes get swept up in treating your disease, and I apologize in advance if you ever feel like we’ve forgotten about the rest of you, but please feel free to remind us. We are experts in medicine, but you are the expert on you.”

I then placed her first IV. It felt like I was firing the starting pistol at a race that this woman really didn’t want to have to run. 

Unfortunately, she wasn’t the last person to get The Talk last night. The second person came in with abdominal pain, something we see often in the ED. While this patient wasn’t feeling all that sick, his story worried me, and on exam he had a large palpable mass in his abdomen. As soon as my hands touched the mass I could envision his CT scan in my mind. We ordered the test, and the actual scan looked worse than what I had imagined. There was really nothing that could look like this except for a widely metastatic cancer. 

It was a very busy night, and my (awesome) attending was running all over the place. I offered to go tell the patient the bad news, imagining that she would probably want to be there for that conversation. But she just thanked me, and off I went. 

I’ve had serious conversations with patients and families, sometimes unsupervised. I had not, however, actually delivered this kind of news before. Of course it was somewhat hedged; cancer is diagnosed by biopsy, not by imaging. But it would have been impossibly dishonest not to tell them that all of the testing we were about to recommend was a cancer workup.

They were fairly stoic about it, which probably made it easier on me, though it made me worry at first that I wasn’t being clear. They asked good questions. They wanted to see the CT scan, so I went over it with them. I gave them The Talk, and they seemed to appreciate it. We wanted to admit him, but they decided to go home and plan further diagnostics as an outpatient, and I felt like The Talk had worked. He wanted to go home, so he did.