An American Medic in Britain via MedWorm.com

Halfway there...

An American Medic in Britain — Thu, 29 May 2008 17:38:00 +0100

So today marked the official end of my last exam of my St. Andrews career. Essentially, I am halfway to becoming a doctor (assuming I passed this round and all future rounds of exams). It's quite scary, actually, but exciting at the same time. In proper St. Andrews tradition, my friend all showed up with massive amounts of water and drenched me the moment I left the Bute building. It was freezing but hey, traditions are traditions, and that's half of what St. Andrews is popular for (the other half being that the prince studied here)/Will be quite busy this summer with revision and other such things, not sure if i'll find time to post. So if not, see y'all next year for the start of my clinicals!-AMiB (Source: An American Medic in Britain)

New cpr protocol

An American Medic in Britain — Mon, 19 May 2008 12:38:00 +0100

Enjoy!Sorry for the lack of posting, been fairly busy with dissertation presentations, studying for final OSCE of St. Andrews, and sorting out living arrangements and other things for next year.-AMiB (Source: An American Medic in Britain)

Comparison of gene expression and dna copy number data to identify amplicons in breast cancer

An American Medic in Britain — Mon, 28 Apr 2008 13:52:00 +0100

Abstract:Breast Cancer is one of the primary causes of death in women in the world. Many genes have been implicated in the predisposition to this disease. In this experiment, chromosomal copy number changes were analyzed alongside gene expression. Using CGH technology, changes in DNA copy number in four tumors were used to detect areas of DNA Amplification. Gene expression levels found on 250k SNP arrays were inspected to match areas of increased expression with the previously found amplicons. Areas of correlated expression were sought in the hopes of locating specific genes being over-expressed, with the possibility they are driver genes of the amplicon, and therefore possible oncogenes. Of the eighteen amplicons found, four yielded posivtive correlation results (correlation hugher than 0.6 within a 1 megabase genomic window). The amplicons on Chromosomes 17, 12, 8, and 6 were analyzed in more detail.I can now honestly say that I am FINISHED with my dissertation, as I submitted it for printing this morning. I still need to do our "portfolio entry" (they love making us 'reflect', as practice for later), as well as fill out a questionnaire, pick up the printed version, and hand it in; but the hard bit is over! Today is alll relaxation, and getting ready for the parties of the week.If anyone wants to check out the full dissertation (no idea why you would), drop me a line and I'll send it your way.-AMiB (Source: An American Medic in Britain)

Quick update

An American Medic in Britain — Wed, 09 Apr 2008 16:37:00 +0100

As the Dissertation deadline for submission draws closer and closer, I realize more and more that I have NO IDEA what I'm writing about. I have a general idea as to the topic and I understand some of the more basic, broad things that I am reading in these articles (all for my intro), but for every 1 thing I read that I understand, there must be 5 more that I have no idea what the hell is going on. I have resigned to just pretend like I know what I'm doing, keep writing a bunch of random words down on paper, and hope for the best.One things for sure - I'm definitely not going into research. (Source: An American Medic in Britain)

1 year blogiversary!

An American Medic in Britain — Thu, 27 Mar 2008 14:51:00 +0100

Today marks the 1 year mark of my starting this blog. I was quite bored during reading week (aka procrastinating) and had been reading medical blogs for quite a while, and decided I should write one myself.To date, I have written 88 posts (much lower than I expected when I started), and have received 6,261 hits (definitely much MORE than I expected!). I have had quite the time this past year, with plenty of things happening, not only to me but the world as well.I would like to say thanks to all the people who read this, and hope you have enjoyed it. I definitely plan to keep this going, especially once I start my clinical time in Preston, so stay tuned!Thanks,-AMiB (Source: An American Medic in Britain)

Fake memories...

An American Medic in Britain — Wed, 26 Mar 2008 12:36:00 +0100

hmm...saw this on a friend's blog, decided to see if anyone here would give it a go!If you read this, if your eyes are passing over this right now, (even if we don't speak often) please post a comment with a COMPLETELY MADE-UP AND FICTIONAL memory of you and me.It can be anything you want - good or bad - BUT IT HAS TO BE FAKE.When you're finished, post this little paragraph on your blog and be surprised (or mortified) about what people DON'T ACTUALLY remember about you.In other news, I have essentially gotten all my data for my dissertation, and my advisor says that "in theory, in two weeks time, I should have written the whole thing". So yeah, basically all during my spring break at home, I'll be writing (if I can motivate myself, that is!) I still have 2 weeks after that to finalize, etc, but it's nice to finally have a deadline, of sorts.-AMiB (Source: An American Medic in Britain)

Me in a nutshell...

An American Medic in Britain — Sat, 15 Mar 2008 14:57:00 +0100

Saw this picture on the internet today, thought it summed up my life quite well lol...In other news, tonight is the Bute Ball, the big medical school ball put on by the Bute Medical Society. At the beginning of my 1st year, I told myself that to the 3rd year Bute Ball, I would wear a kilt (and associated outfit). Well, that day is finally upon us, and the kilt is here (rented). I'm quite excited but also a little apprehensive...we'll see how it goes.-AMiB (Source: An American Medic in Britain)

Qub scrubs emergency medicine 2008, day 1

An American Medic in Britain — Thu, 06 Mar 2008 22:02:00 +0100

So, Day 1 (of 2) is over of the QUB Scrubs Emergency Medicine conference for 2008. It was pretty good, although a lot of the morning lectures I've heard before (ABCDE, causes of SOB/ACS, etc etc), but it was still fun because the friends who came with my from St. Andrews and I were passing writing notes to one another on our little notepads...After lunch, there was a circuit of 6 skills stations, including Cannulation, ABG taking, ABG interpretations, some Sim-Man sessions with the Territorial Army, which were really awesome because I got to use my ABCDE skills from the ILS sessions as well as my EMT-B training from back home to care for a "soldier" (SimMan dressed in army gear) who had been a prolonged extraction from an crash.Tomorrow looks to be interesting as well, with different lectures including things like Diabetic and Obstetric Emergencies, as well as more skills stations, like suturing and defibrillation.Anyway, my friends and I are going to relax after a MASSIVE dinner at Villa Italia, and might just watch a movie and get ready for tomorrow!-AMiB (Source: An American Medic in Britain)

Emergency medicine conference

An American Medic in Britain — Wed, 05 Mar 2008 12:36:00 +0100

Later tonight 3 friends and I are headed over to Belfast for the Scrubs QUB Emergency Medicine Conference (http://www.qubscrubs.co.uk/conference). I went back in first year when it was the first year of the conference, and I LOVED it. It looks to be bigger and better this year, so I'm quite looking forward to it. I will hopefully post pics/update, but then again, I seem to be neglecting my blog more and more recently. If by chance you're headed to the conference as well, drop me a line! (I'll have my laptop with me)-AMiB (Source: An American Medic in Britain)

Awesome.

An American Medic in Britain — Mon, 25 Feb 2008 11:13:00 +0100

Each of you [visitors] will be getting a different "fact" about me...feel free to refresh to get another one lolLast Friday and Saturday were two of the best days of medical school I have had so far. Friday was the first Cycle of MD4003 - Applied Medical Sciences. Besides our dissertation, it is the only class we have, taking up an entire Friday (9-4) once every fortnight. Hopefully I will find time to elaborate later (although I seem to find plenty of time to find meme's online...hmm). Friday I and 29 of my colleagues became ILS (Immediate Life Support) certified by the Resuscitation Council of the UK. It was basically a refresher of what I did back in the summer when I became an ACLS Provider back home in the states. It was still great fun, and luckily no one killed anyone with the defibs (they were live). The instructors were pretty laid back and funny, too, which always helps. Although after one of them gave the lecture on the ALS Algorith, I went up and asked him about a couple discrepancies between the UK algorith and the USA/AHA algorithm. He sort of laughed when I said I was American (I get that a lot), and then seemed to pick on me a bit for the rest of the day. Or maybe I was imagining it. At one point though when we were practicing, a put my stethoscope around my neck (y'know, because its the simplest place to put it), but then he came up to me and asked if I was a doctor and if not then why my scope was around my neck. I guess in Tayside they don't allow anyone but Consultants to wear them. Weirdos.-AMiB (Source: An American Medic in Britain)

Snp snp

An American Medic in Britain — Wed, 20 Feb 2008 20:48:00 +0100

So I had another meeting with my dissertation adviser today, and I think we've changed my project completely. It's ok though, because this one doesn't go completely over my head like the last one.From what I understand, I'm meant to analyze patterns in 4 biopsies of breast cancers, look for DNA amplicons, and try and match them to known gene transcription regions in the human genome. For example, on chromosome 17, there is a large area of DNA amplification on the "q" segment (lol don't I sound fancy - I barely even understand what I'm saying!), and when you match that to the human genome, you see that this is the are in which the HERB B2 binding site is. This is the major site of action of the relatively new anti-breast cancer drug, herceptin. So basically I'm supposed to spend the next few days or so looking at different amplification regions, and looking for patterns of areas of genomic transcription. Or something like that. Maybe I've completely misunderstood, or am just spewing complete BS to look smart.Probably that last one. lol.-AMiB (Source: An American Medic in Britain)

Dissertations

An American Medic in Britain — Fri, 15 Feb 2008 08:53:00 +0100

So it looks like I'll be doing some type of research about p53 transcription factor binding sites for my dissertation. If that went over your head when you read it, don't worry - it went straight over mine too, especially when my advisor was trying to explain it to me. All I know is that p53 is a protein that regulates the cell cycle, and it's very important in cancer.From what I understand about the project, which he said was origianlly supposed to be a PhD project for a Bioinformatics PhD (WTF?!), he wants me to use some random online genome browsers etc to search for p53 transcription factor binding sites, and find all the ones that have to do with cancer. Or something like that. I'm still not completely sure yet. We'll see how that goes lol.In other news, the Deans of the Manchester Hospitals are coming for their annual visit next Wednesday, if I have time/remember, maybe I'll make a post about how it went. I tend to neglect this blog, even when I don't have a lot of stuff to do. However with this new, semi-empty schedule of this semester, I've had to schedule my own life (Outlook(r) runs my life!) and I tend to leave out things like "blogging" and "relaxing" times lol.Also, USMLE revision has slowly begun. Some colleagues and I have set up a small weekly study group, and while our first meeting was somewhat of a bust, I think it should get better. Hopefully I (and everyone else) will actually do the work before the session this time.On the fitness front, I am trying to use this open schedule to my advantage. I wrote a 3-day workout plan for me and my 2 gym buddies, and it's pretty hardcore, if I do say so myself. I've also started taking some new supplements (including a ridiculous 11-tablet multivitamin that turns your piss bright yellow [but don't worry, those are just the B-vitamins]), but I won't really talk about them on here until they work (or not). I am also going on morning walk-jog intervals (I hate calling them runs/jogs because a majority of the time is spent walking, with intermittent jogging) with one of my gym buddies (the other won't wake up that early). All this combined with a 1300-calorie-a-day deficit is keeping me on track with my new short-term weight/body fat loss goals.So, while I realize this is quite the random post about everything, I'll summarize by saying everything, all in all, seems to be going quite well (and of course the moment I post this something will go horribly wrong).Until next time,-AMiB (Source: An American Medic in Britain)

Happy superbowl sunday!

An American Medic in Britain — Sun, 03 Feb 2008 21:58:00 +0100

In my eyes, the #1 SuperBowl commerical of ALL TIME:and yes, I DO consider today a holiday. lol.Enjoy the game, everyone! (Source: An American Medic in Britain)

B-52, eh?

An American Medic in Britain — Sat, 02 Feb 2008 04:37:00 +0100

Stolen from ADWhat military aircraft are you?B-52 StratofortressYou're a B-52. You are old and wise, and you absolutely love destruction. You believe in the principle of "peace through deterrence" and aren`t afraid to throw your weight around. (Source: An American Medic in Britain)

Cherry chocolate diet dr. pepper

An American Medic in Britain — Wed, 30 Jan 2008 23:30:00 +0100

Oh my god. I love the new Dr. Pepper flavor. My sister hates it, but I tend to go for these off the wall type flavors (including the last Dr. Pepper creation - Cherry Vanilla Dr. Pepper).In other news, I'm bored sitting here at home with nothing to do. I should probably start some USMLE Step 1 revision, but I can't seem to motivated to get my @$$ off my bed long enough for anything besides eating and going to the gym. If anyone has any recommendations as to how to pass the time, please send them my way :-D-AMiB (Source: An American Medic in Britain)

The 6 month mark - a.k.a. the "secret" to weight loss

An American Medic in Britain — Sun, 27 Jan 2008 20:06:00 +0100

Disclaimer: Any product endorsements written here are solely based on personal experience and preference. I have not been paid/bribed/bamboozled/hypnotized into writing anything, good or bad, about them, so yeah...Today (January 27th, 2008) marks the 6 month anniversary of the day I turned my life around.I was a 6'3", 280lbs (127kg/20 stone), and 29.1% body fat. I had always seemed to have been in denial about my weight - I always knew I was big (I was 10.5lbs at birth - and only went up from there), but I never really thought I "looked" it. My entire life, my parents had been on my case about my weight, always telling me to exercise (but also always feeding me so much), but I would never listen. I had high cholesterol (although I also have a bi-parental history) and my blood pressure was starting to look dangerous. This, as you may imagine, is not normal for a 19 year old boy. But even still, I wrote it off - I had always been happy being 'big', except of course when I would be out of breath and sweaty just from walking to class. I had tried to lose weight in the past, but like many, never succeeded.Then, something seemingly small led to something big: on our family trip to the Dominican Republic, I wasn't allowed on the free horse ride because they had a 200lb (90kg/14.3 stone) limit. This didn't bother me at all, but when we got back to the hotel, my parents had a fit. When we returned home, my mom called a family friend who had worked with a personal trainer, and we called him. The next day, July 27th, 2007, was the day my life turned around - the day I started with my personal trainer at 24hour Fitness, my bodybugg, and my new life.The dieting and the exercise started immediately, and is quite literally the "secret" to weight loss. It's simple math: Calories Out - Calories In = Weight Lost. I was introduced to the bodybugg, and while the price was a pretty steep deterrent, we decided to go for it. Basically, you wear the bodybugg on your arm all day (and all night, if you prefer - I don't because I tend to sleep on my side), and then plug it into your computer. It uploads the information that it takes from a bunch of sensors inside, and uses them to calculate how many calories you've burned. It's surprisingly accurate, and not only gives you the day's total (or how much so far that day), but displays graphs of minute-by-minute burn. It's quite amusing to be able to visually see how certain things increase your burn, e.g. working out, and how others bring it back down to your BMR (basal metabolic rate), like sitting on your butt watching TV. It also asks you to type in the Nutritional Information for the foods you've eaten that day, and I think this is the major player in the weight loss. Having to type in your food leads to a certain amount of personal accountability. It makes you constantly look at the BACK of the food container, where the important stuff is, not just the front, where they try and lure you in with how tasty their food looks.Using the information it has from your bodybugg and the information you give it about your food, it calculates a deficit/surplus (I can proudly say I have never been in a surplus - not even on Thanksgiving), which helps you estimate how much weight you should be losing. The bodybugg creates a "goal" burn, intake, and deficit based on how much weight you want to lose, and by when. As long as you stick to the numbers it gives you, you'll be on track to your goal in no time.So, back to my story - I was in the gym, with my trainer, 5-6days a week, moving from core stabilization to resistance training, followed by cardio. With everything I have experienced in the past 6 months, I will say (as will countless other fitness buffs out there) that those are the 2 key ingredients (along with diet) to maximize your weight loss. Cardio burns calories like no other (especially the elliptical trainer, rowing machine, and treadmill), and resistance training strengthens your body and adds muscle mass, which increases the amount of calories you burn all day.The only "supplement" I used all summer was a protein powder called Muscle Milk. Protein shakes after workouts are important for keeping your lean muscle tissue (although with any drastic amount of weight loss, expect a significant drop in lean body mass) and to maximize the effectiveness of resistance training. I had tried other protein powders in the past as well, which is why I was skeptical of this as well (as you may tell, I went into this whole 'personal trainer' business warily, constantly keeping watch for scams, etc). But again, I decided what the hell, and bought it. It was actually pretty tasty, but whether it had any significant effect on my loss, I can't tell you for sure.With this routine of diet and exercise, the pounds started falling off (see the "Progress" column, to the right - now you all know what it is, if you haven't figure it out already lol). By the time summer finished and it was time for me to get back to school, I was down to 251.5lbs (114.3kg/17.9stone) and 22.4% body fat. I felt like a changed man - my clothes fit better, I had more self confidence, and people were noticing a difference (it's an amazing confidence boost, let me tell you!).However, I wasn't even closed to finished (and I'm still not). When I returned to University, I decided not to let the ridiculously unhealthy hall food and freezing weather ruin all my hard work. I continued making the right choices about what/how much I ate, and I was back in the gym, Monday-Wednesday-Friday. For those of you who find going to the gym tedious and boring, a tip I suggest is finding a friend who thinks the same thing. Not only will you keep each other motivated (the friend I go with constantly calls me fat-ass - but only after I started dropping the weight - it's an amusing incentive to constantly prove him wrong), but it makes the workouts go quicker and makes them more fun.By December, I was down another 30lbs and 6% body fat. My clothes were no longer fitting (I have never, in my life, been able to say that something was "too big" for me - I was as big as they come, with a 52" chest and 42" waist.) But this Christmas break, amongst the multitude of sales, I was finally able to buy nice clothes that fit well, rather than having to settle for whatever came in my size. I'm down to a 44-46 chest and a 36-38 waist. It's absolutely amazing.Essentially, I'm writing this whole story as a motivation to those like me. If you put your mind to it and set goals, you can do it. It just takes the right mindset, attitude, and some basic knowledge of what you're doing to achieve what you want. Emotional support from family and friends helps too. Who knows, you might even get a poster up in your gym like I do now!I am currently at ~220lbs (100kg, 15.7 stone) and 20% body fat, so I'm not even close to being finished. Who knows, if both the weight loss and this blog keep going, maybe you'll see another post such as this one in another 6 months :-)If any of you need advice, motivation, information, workout/diet plans, etc, feel free to leave a comment and I will gladly help where I can.-AMiB (Source: An American Medic in Britain)

Traveling time, once again...

An American Medic in Britain — Thu, 24 Jan 2008 14:39:00 +0100

So I'm currently sitting at my gate, waiting for my flight back home to start boarding. The travel this time has been surprisingly easy, completely contradictory to the normal airport/airline stereotypes I usually run into. I had an empty check in line, cleared through a nearly empty security checkpoint, and had a fairly empty domestic flight (am currently waiting for my international flight).Uh oh, they just called the boarding. I am looking forward to 2 weeks of nothingness at home!-AMiB (Source: An American Medic in Britain)

Vizd winner!

An American Medic in Britain — Mon, 21 Jan 2008 19:36:00 +0100

Looks like I won last week's VizD challenge. If you haven't ever checked out NY Emergency Medicine, it's a great site, and it has a weekly challenge called "VizD":VizD is a weekly contest of an interesting or pathognomonic image from emergency medicine. Its goal is to integrate learning into a fun and relaxed environment. All images are original and are posted with the consent of the patient.Well, last week was clubbing, and since it was one of the only VizD challenges I have ever been able to answer fully of my own accord (eg without google/wikipedia), I submitted answers, and it looks like I won! It's always a plus when theres something random like this showing you that you're actually soaking up some of the information they throw at you :-PSo yeah, check it out!-AMiB (Source: An American Medic in Britain)

Heh heh...

An American Medic in Britain — Mon, 21 Jan 2008 17:55:00 +0100

OSPE on Wednesday. I was a patient for 2nd year OSPEs today...might write a post with the amusing things they all did (e.g. "On Palpitation and Awskyoolation")...We'll see how it goes. For now, enjoy the comic-AMiB (Source: An American Medic in Britain)

Because cal doesn't believe me...

An American Medic in Britain — Tue, 15 Jan 2008 08:38:00 +0100

I took the thing again.92 wordsTouch Typing onlineAnd to prove it: (click)heh. and the spanking continues...-AMiBp.s. If I fail my exams tomorrow, I'm blaming you. (Source: An American Medic in Britain)

A little de-stress before bed...

An American Medic in Britain — Tue, 15 Jan 2008 00:04:00 +0100

88 wordsfree Touch typingSeen on Short White Coats.off to bed so i can wake up early, been doing this early morning cardio thing and it leaves me quite tired throughout the day, more from the lack of sleep than anything else.-AMiB (Source: An American Medic in Britain)

Contrary to popular belief...

An American Medic in Britain — Mon, 14 Jan 2008 11:32:00 +0100

I have not fallen off the face of the planet. I am currently busy studying for my exams, which will be over soon (SAQ on Wednesday, MCQ on Friday, OSPE on the following Wednesday). I am horribly behind schedule on revision, and as such, will get back to it now.I will try and update on life later.-AMiB (Source: An American Medic in Britain)

Happy new year, 2008!

An American Medic in Britain — Fri, 04 Jan 2008 06:07:00 +0100

Hey guys, I know its a few days late but Happy New Year everyone! My family and I went on quite a long road trip last week, visiting family and family friends along the way. New Year's eve was pretty tame, watched Ratatouille and Hot Rod.Along the trip, we spent a night with a family friend who is an Internal Medicine/Hepatology Physician. We went on a tour of his new office, and let me tell you, the feeling I got when I walked in there made me want to reconsider a future in an office-based practice. He runs a totally paperless practice, using EMR software called eClinicalWorks. It was pretty awesome, letting him do basically everything he/the nurse/the receptionist needs to do, and its all amalgamated into one piece of software. I promise I'm not being paid to toot their horn, and all the info I've seen on it is based on the little 10-minute run through that he gave me, but it looks like my kind of office lol. Computers in each exam room (I would go with a single tablet PC, but whatever), a computer for the nurse, one for the receptionist, and involved faxing prescriptions, telephone records, everything.SO, I was kind of excited for a little bit, and then all of a sudden, our family friend doc starts talking about how the work he puts in isn't really being reciprocated by reimbursements, etc. He was one of the few people to try and convince me to go into ER medicine. Anyway, that's definitely something to think of in the future...we'll see how it goes (gotta pass the Step 1 first!)As my winter break comes to a close, I'm not looking forward to going back to St. Andrews for a week of revising and then 2 weeks of exams...but I definitely am looking forward to the 2 week break after that - one of the good parts of the St. Andrews calendar :-D-AMiB (Source: An American Medic in Britain)

Merry christmas, 2007!

An American Medic in Britain — Tue, 25 Dec 2007 18:32:00 +0100

Merry Christmas everyone!I hope you all got what you wanted!-AMiB (Source: An American Medic in Britain)

It's that time of year...

An American Medic in Britain — Thu, 20 Dec 2007 17:43:00 +0100

So, Christmas break is just around the corner (finally)! We third years have our last lecture of the semester (and technically, our last lecture of St. Andrews) tomorrow. We're all quite excited.Today I spent the afternoon giving tours of the Bute to prospective students who have just been interviewed. I've done this a number of times, but today was more fun than I remembered...can't quite put my finger on why, but oh well.I'm leaving for home Saturday morning. By Saturday morning, I mean my flight leaves at 6.30am. Which means I have to be there at 4.30am. Which means I have to get a taxi out of St. Andrews at 3.30am. Thank goodness I know a bunch of people who are on the same flight, so instead of paying the £50 myself, its down to £12.50. I'm quite looking forward to going home though, especially since none of my clothes seem to fit me anymore, and I'm excited to get some new ones.Anyway, I really need to finish some more work before I go home. The plan was to be caught up and have all my notes, etc, done before I left. We'll see how that works, since I have a mandatory Skills Practice from 9-10am tomorrow, and a lecture from 12-1pm. And I haven't even started packing yet. Hopefully things will be fine.Just felt like I should do a quick update, sorry its such a random dissociated post.Only 5 more days till Christmas!-AMiB (Source: An American Medic in Britain)

Twenty, eh?

An American Medic in Britain — Fri, 14 Dec 2007 12:36:00 +0100

20This is one of the more..."interesting" meme's I've taken, yet the questions/responses are still quite amusing.How many can you handle?-AMiB (Source: An American Medic in Britain)

How fitting...

An American Medic in Britain — Tue, 11 Dec 2007 17:08:00 +0100

Which Action Hero Would You Be? v. 2.0created with QuizFarm.com You scored as William WallaceThe great Scottish warrior William Wallace led his people against their English oppressors in a campaign that won independence for Scotland and immortalized him in the hearts of his countrymen. With his warrior's heart, tactician's mind, and poet's soul, Wallace was a brilliant leader. He just wanted to live a simple life on his farm, but he gave it up to help his country in its time of need. William Wallace 83%James Bond, Agent 007 67%The Amazing Spider-Man 67%Maximus 67%The Terminator 67%Neo, the "One" 54%Batman, the Dark Knight 54%Indiana Jones 54%El Zorro 50%Lara Croft 42%Captain Jack Sparrow 42% (Source: An American Medic in Britain)

Clinical medicine module: cardiology

An American Medic in Britain — Thu, 29 Nov 2007 21:13:00 +0100

So, today was the second clinical attachment for me, the Cardiology attachment (I got to pick this one, and since I quite like Cardiology/Cardiovascular system, I picked it). I was pleasantly surprised to find that it was in Kirckaldy instead of Dunfermline, as the latter is an extra 20 minutes out. On arrival we went up the Education Centre, and then were forwarded on to the Cardiac Care Unit. 6 of us went with each Consultant (and switched halfway through). It was in the same general format of the Surgery Rotation, except more about heart failure and acute MIs. It was pretty interesting, and since I've always tried to be on top of my game on cardiac issues (since we see so many flowing through the ER), I was pretty on my game. At one point (after I answered that the treatment for a axillary vein blood clot s/p pacemaker placement would be a LMWH e.g. enoxaparin), the Consultant joked about "when I could start". It kinda made me feel like all those [unpaid] hours at the hospital really paid off. Bit of a confidence booster, if you will. The first consultant mainly dealt with cardiac causes of dsypnea as well as heart failure. He then showed us echocardiograms from the patients we had seen - I had never actually been taught what to look for, but he did a very good job at giving us a brief intro.The second consultant took us to see a patient who had had an acute MI, was stented (I believe), and due to a bradyarrhythmia had a temporary pacer placed. Then after a bit of ECG review, we were let go.Overall, I enjoyed it a lot more than the Surgery one, maybe because I've always leant toward Cardiology as a possible career choice...who knows?In other news (one of which is semi-related to today):Over the past few days i've seemed to develop a URTI. Most probably viral, and I'm trying to get through it. Got myself some Halls cough drops and some dextromethorphan/pseudoephedrine cough syrup, and it seems to be working pretty well. Also, today I decided that since I always get so nauseous on the bus to our attachments, that I would try one of the hyoscine(/scopolamine) tablets that I have. Now, I've never needed to take this kind of thing before - usually I just deal with the nausea - but I figure hey, why not? The whole bus ride went fine - we got to the hospital, and I figured everything was gonna be good.Then I stepped off the bus. Immediately I could tell something was wrong. I didn't seem to be able to walk straight, my eyes were...funny. They weren't blurred, everything was just so...different. Not really sure how to explain it (well actually I do, we'll get to that later). However, I continued on and we all headed to the Education centre, Cardio floor, etc. The whole first hour or so, not only was I coughing up a storm, but I was having trouble speaking (bit of dry mouth?) and just coordinating in general. Things got better, over time though. So, hyoscine is an anticholergic - loss of pupillary constriction due to imbalance between para&sympathetic systems lead to the weird vision (must've had huge pupils - letting in a lot of light). Dry mouth is an anticholinergic side effect as well. I was trying to remember the rhymes for anticholinergic overdose, but all that came to mind was "Mad as a Hatter", and I sure as hell wasn't seeing things or grasping in the air - so I figured I'd be ok. It slowly drifted away, but I still feel kinda funny...hopfully it'll wear off by tomorrow.And, in OTHER other news, I got a 17 (on the 1-20 scale that our Uni uses) on my midsemester assessment! (that's the lowest mark of a 1st class). Seeing as how I've never been able to get higher than a 15, I was quite happy. Except I know it was only because I did well on 2 questions that most others were fairly unprepared for...just means I'll hope to keep it up in the end of semester exam!!-AMiBp.s. it still freaks me out every time my sitemeter shows someone from within the University viewing my page...lol (Source: An American Medic in Britain)

Happy raisin sunday, 2007!

An American Medic in Britain — Sun, 25 Nov 2007 13:19:00 +0100

Happy Raisin Sunday!Raisin Sunday is a tradition here at St. Andrews that has evolved over the years...Rather than type out the traditions, etc, I am stealing the article from The Sinner:Raisin Weekend is centered around the unique St Andrews tradition of the "academic family".Each first year (or at least those who choose to take part - it is not compulsory) is adopted by an academic mother and academic father - who are usually, but not always, in their third or fourth year. In one form or another, Raisin Weekend has been around since the very earliest days of the university. It was, and still is, a "rite of passage" for new students. On Raisin Sunday, first years spend the day with their academic parents. First of all, they attend a tea party with their mother at which, traditionally, not much tea but a great deal of alcohol is consumed. Later, the children are collected by their fathers and the evening is spent in the drinking of yet more alcohol. In return for their parents' kindnesses, the first year is expected to give them each a bottle of wine. This is deemed the modern equivalent of a pound of raisins (actually, the modern equivalent of a pound of raisins IS a pound of raisins) which was the usual gift way back in the mists of time when students had a bland diet (has this changed much?) On the following day (handily called Raisin Monday) and after being woken up, sobered up, cleaned up, and dressed up in outlandish clothes, freshers are presented with their Raisin Receipts. These are written in Latin and is a way of acknowledging the gift of raisins. They always used to be on parchment. Nowadays, almost certainly, the receipt will be something large, embarrassing and cumbersome which has to be carried around. The gift-giving does not end here. Academic mothers give each of their children "Raisin Strings" with a small gift attached. The gift or "favour" is supposed to reflect the personality of the child. The number of Raisin Strings depends on the status of the mother. It is one string per year of matriculation - blue for first year, crimson for second, gold for third and black for fourth. These strings, with gift still attached, will eventually be tied to the child's gown hooks. After all this largesse, children are paraded through the town until they arrive at Sallies Quad. En route, third years, fourth years and graduates of the university (if they are wearing their gowns) can stop any fresher and examine their Raisin Receipt. If they find a mistake in it then they can demand that the Gaudeamus be sung as punishment. Once at Sallies Quad, between 11 and 12 o'clock, a foam fight nearly always breaks out - it's almost traditional. The striking of 12 o'clock means the end of the fun for another year, and sees students slowly drifting off. Parents perhaps to have photos developed. Freshers, almost certainly, to sleep.So, there you have it. Last year I had 20 children, 10 sons, and 10 daughters (no I did not pair them up, although Academic Incest is widespread within the University) - this is allowed since Medics are technically one year ahead - we do a 4-year degree in 3 years, so in first year we are taking 2nd year class, in second year we're in 2rd year, etc...It was a lot of fun, but this year as Big Grandpappy AMiB, I will be party-hopping, trying to enjoy myself while making sure no one dies from alcohol poisoning.-AMiB (Source: An American Medic in Britain)

Happy diwali!

An American Medic in Britain — Fri, 09 Nov 2007 12:26:00 +0100

Happy Diwali, everyone!It's pretty hard for me to celebrate by going to a mandir, since the nearest ones are in Dundee (which seems to always be closed) and Edinburgh, and since this coming week is Reading Week and all, I'll be pretty busy preparing for my Mid-Semester Assessment (which counts for 25% of my module mark - the other 75% being from my End of Semester Assessment).Oh yeah, and I also got allocated to Preston, which I have a lot to write about, when/if I have time.-AMiB (Source: An American Medic in Britain)

Happy halloween!

An American Medic in Britain — Wed, 31 Oct 2007 14:52:00 +0100

That was me as a kid lol (not really...but it easily could have been). Tonight our Hall of Residence is having another Halloween party, and since I'm now on the Committee (Overseas Rep), I get to serve the alcohol for the first two hours. I can hear the American readers now - "your dorm GIVES you alcohol?!" - but it does me no beneift (except maybe on my ABC-assessment/BLS skills lol), since I'm teetotal. But that won't stop me from having a good time (never does). This year, I'll be taking the medic's "easy way out" of a costume, and wearing the scrubs I uhh...'borrowed' from my hospital back home, my lab coat (used only for dissection here, which is why it's currently in the washer), and my stethoscope. We'll see how it goes.I leave you with this:Happy Halloween, everyone! Be Safe!-AMiB (Source: An American Medic in Britain)

I love work! :-d

An American Medic in Britain — Mon, 29 Oct 2007 11:03:00 +0100

So, as Week 5 begins, I'm starting to freak out more and more. We have 12 hrs of class this week, and 14 next week (both less than normal), and then Week 7 is our University-wide "Reading Week". I don't really know why they call it that, unless for us medics. Everyone else in the entire University goes traveling or drinking (more than they already do during term) or home or something. The medics? We lock ourselves in the library/study/computer rooms and "revise" everything we've "learned" in the past 6 weeks.Then Day 1 of Week 8 is our Mid-Semester Assessment, which counts for 25% of our module mark (the other 75% being our End-of-Semester Assessment). Then we continue on with our busy schedules until Christmas Vacation, which is a 2 week break spent - you guessed it - studying! Because exams are a week after that lol. I shouldn't really be complaining though, from what I hear they have it a lot harder back home, both in terms of workload and continuous assessment.Alrighty, time to get back to it, I guess. Sedatives and Anxiolytics! Maybe I need some of those...-AMiB (Source: An American Medic in Britain)

Good day

An American Medic in Britain — Wed, 17 Oct 2007 20:19:00 +0100

Every so often, a day comes around that is just...good. Today was one of those days. Allow me to explain:8.30am - woke up, had breakfast11am - started the 2 lectures for today (Pharmacology - Neuroleptics and NeuroPhysio - Learning and Memory)1pm - lectures finished, hop on over to the Union for AsianSoc meeting. everyone is pumped about BINDI·, including me.2.30pm - got home, wrote up both lectures from today (completely ignoring the fact that I am behind on 11 or so anatomy lectures)5pm - go to gym. Back and triceps today, and since the whole routine for today only takes 45 minutes or so, I had time for some Cardio (rowing machine) as well. burned a lot of calories, says my bodybugg.6.15pm - Dinner. not the best, but whatever - its New Hall food, so yeah.7.30pm - Prepped for Dissection tomorrow. Not as much as I should have, but enough to answer a few questions so they don't think I'm retarded, but not enough to be considered too "keen" (lol love that.)I played World of Conflict for a little bit, chatted with some friends, and will be headed over to a friend's to watch the latest Heroes and CSI Miami.Even had time to write a blog post. Awesome.-AMiB (Source: An American Medic in Britain)

Clinical medicine module: surgery rotation

An American Medic in Britain — Sun, 14 Oct 2007 17:23:00 +0100

So last Thursday was my Surgery rotation as part of the Bute's new Clinical Medicine Module. We're basically the guinea pigs for this, but at least most of the kinks from last year's class had already been worked out. It was basically what I imagine an Introduction to Clinical Medicine class would be like if I were back home. There were 6 of us, and one Consultant (an Attending, back home), and we basically just went on a small Ward Round. He would explain to us basic things, do a lot of basic science pimping, as well as explaining some more of the semantic things about patient care (DVT prophylaxis with LMWH and stockings, etc).For those of our class who have no/little hospital experience from a patient carer standpoint (eg doctor/nurse, as opposed to clerk), I think it was very beneficial. I'm not trying to sound cocky, but most of the stuff he told me I learned this past summer with the Hospitalists. However, he did show me how much basic anatomy I had forgotten over the summer/past year.Overall I think it was pretty good, and while I was really looking forward to my A&E day next sememster, it turns out that it's just a ortho fracture review...but the Consultant offered everyone some Saturday night shifts in the A&E doing proper work, so I might just...pretend I have already met him and take him up on the offer :-)In other news, I am very behind in my work. We have mainly only had Anatomy lectures so far (Head & Neck, and CNS), with a little bit of Pharm (General Anaesthetics, etc) thrown in for fun. I have written up 3 of the 15 lectures we've had, and more start tomorrow....*sigh*. That's med school for you...-AMiB (Source: An American Medic in Britain)

Update...

An American Medic in Britain — Sat, 06 Oct 2007 14:17:00 +0100

OK, so I really have been neglecting my blog lately, which is probably why my visitor count has slowed to a trickle...We are currently studying the anatomy of the Head and Neck, and I am sitting here trying to write notes, but it just turns in to me re-writing the book onto pieces of paper...not the most efficient method, but I can't seem to think of any other way right now...we'll see if it helps or not.Out school as recently implemented a new clinical attachments scheme for the 3rd years (that's us!), so this coming Thursday I will get a 3-hr attachment with a Consultant Surgeon and his colleagues/team. I'm not really sure what to expect, or how much I'll get to do/learn in 3 hours, but it should be good and I'm quite looking forward to it. I also get a Cardiology attachment on the 29th of November, an A&E (ER) attachment sometime next semester, and another one of my choice next semester (hopefully Respiratory, it sounds fun).Alright, that's the update, time to get back to the work. A friend is making a [Canadian] Thanksgiving dinner tonight (Canadians have theirs a lot earlier than we do), so am v. stoked for that - sorry, that was the 19 year old in me speaking.-AMiB (Source: An American Medic in Britain)

Back in st. andrews...

An American Medic in Britain — Sat, 22 Sep 2007 16:20:00 +0100

So I made it back to St. Andrews last night, and am currently involved in orienting Freshers (first years) to our Hall of Residence. Posts will probably resume once Fresher's Week is over.Funny Quote from a Neurosurgeon a friend was working with over the summer:Neurosurgeon: "And what should the patients [lab value] be?"Intern: "Umm...I'm not sure"NS: "Well f'ing guess then!"Intern: "Umm...50??"Neurosurgeon: "NO! There is no guessing in Neurosurgery!!"-AMiB (Source: An American Medic in Britain)

Leaving, on a jet plane...

An American Medic in Britain — Thu, 20 Sep 2007 04:37:00 +0100

Cliche title, I know. Anyway, tomorrow I start the ridiculously long journey (like 23hrs total travel or something) back to St. Andrews. I should arrive at my hall at around 6ishpm GMT time (and have a meeting at 7pm. Great..)I will continue my "What I Learned" series when I get back. For now, I must pack, get ready for Fresher's Week, etc.-AMiB (Source: An American Medic in Britain)

What i learned this summer, part 2

An American Medic in Britain — Wed, 19 Sep 2007 20:38:00 +0100

When treating DKA, you cannot stop treatment before the bicarbonate has been corrected (~22-24)When a joint is inflamed, always feel the temperature - Warmth could be significiant of a septic jointWhen doing arthrocentesis of the knee, find the bottom of the patella, and go medial OR lateral (Dr. A thinks lateral is better)7 Causes of Monoarticular ArthropathySeptic JointsGonococcal InfectionGoutPseudogoutBechet'sTraumaReactive ArthropathyGoutno need to tap if suspected in 1st metatarsaluric acid crystals found on microscopy90% due to under-excretion of uric acid10% due to over-productioneither way, Rx is NSAIDs + steroidsin over-production, add allopurinolPseudogoutCalcium oxalate crystalsTx is NSAIDs and steroidsSeptic Joint will have >50,000 WBCs on microscopyTrue Iron deficiency shows low iron AND low iron saturationFor the first 2 weeks s/p Acute CVA, allow for autoregulation of BP, except in hemorrhagic strokeAIDSCD4+ < 200 =" AIDSCMV RetinitisToxoplasmosisEsophageal CadidiaTBMAI ReccurentKaposi's SarcomaCryptosporidiumLymphomaGeneral wasting, CD4+ countAIDS --> treatCD4+ < 350 =" treatCD4+ 350-500 = treat if >60,000 viral loadCD4 >500 = don't treatIf HAART works after 8 weeks, viral load should be goneIf viral load is still present, they are resistant to part/all of the regimeGeno/phenotyping to help determine what anti-virals to useMost common cause of Pulmonary HTN that is not easily explained is a chronic pulmonary embolusDVT's below the knee = no treatmingDVT's above knee = Coumadin (warfarin)Recurrent DVT's = indication for continuous anticoagulationBest place to look on 12-lead EKG for A-Fib are in the inferior leads - II, III, aVF (Source: An American Medic in Britain)

What i learned this summer, part 1

An American Medic in Britain — Wed, 19 Sep 2007 06:23:00 +0100

So, since I spent most of this summer prancing around the hospital in my shirt&tie or scrubs, pretending to be important, I decided I should have something to write down all the little tidbits that I pick up. Many of them are clinical "pearls", some are things that I just wrote down off of UpToDate (I mean uhh...my Attending stated it to me word for word, cuz stealing would be a Copyright Violation:-/), and some are just random things that a normal medical student would know that I didn't (aka the answers to pimping questions). So I decided it would be fun if I shared them with you. I've got 1 and a quarter (guesstimate) little shirt-pocket notebooks filled with info, so it make take more than 1 post. So without further ado, here we go:After every 6 units of blood, Calcium must be administered to help the clotting cascade.Consequences of ErythropoietinHigh BP (HTN)SeizuresIn Endocarditis,Janeway lesions --> no painOsler nodes --> painCLUBBING Acronym for causes of ClubbingC - cyanotic heart diseasse/Cystic FibrosisL - lymphomaU - ulcerative colitisB - bronchiectasisB - bronchogenic malignancyI - idiopathic pulmonary fibrosisN - neoplasmsG - granulomatous diseasesPart of DDx of BRB in Stools:Diverticular bleedAterio-venous malformationsnot too commonusually in lower GIMMSE (Mini-Mental Status Exam)out of 30 points28-30 = probably not demented25-27 = borderline~13% of >75yo's have a MMSE 12 or BUN>1002 Major Abx that cause Antabuse-like reactions when taken w/ alcoholMetronidazole (Flagyl)IsoniazidWhen UTI culture shows Proteus Mirabilis, a urea-splitting organism, investigations for staghorn calculi (e.g. Renal US) must be performedNEVER use Levaquin (levofloxacin) when pt is on Coumadin (warfarin) - raises INR dramatically (=bad!)Bicipital tendonitis - hold arm to chest wall; with flexed elbow, rotate humerus laterally while palpating the bicipital tendon (where bicep originates in shoulder) - if inflamed, will cause intense painPancreatitis (elevated Lipase) + Elevated ALT = Gallstone Pancreatitis3 Leading causes of cough:Post-nasal dripAsthmaAcid reflux (GERD)Pneumonia (PNA)crackles/ralesCXR lags 3/4 weeks behind clinical (fever, O2 Sat, etc), even after pt feels betterBUN more specific on CMP for PNAPut on abx: macrolide, 3rd generation cephalosporin, and broad spectrum flouroquinoloneSeptic Joint/Nongonoccocal arthritis is sometimes the presenting complaint in Infectious EndocarditisCauses of Macrocytic AnemiaReticulocytois (reticulocytes are macrocytes)AlcoholismLiver diseaseInterference with DNA synthesisFolate or Cobalamin (B12) deficiencyDrugs e.g. hydroxyurea, methotrexate, etcMyelodysplastic syndromesHypothyroidismHyperlipidemiaWhen Increased Creatinine or ARD is due to drug rxn, urine may contain eosinophils - test for themWhen alcoholic patients develop constipation, they develop hepatic encephalopathy - treat with lactulose to move bowels, and thiamine/multivitamins (e.g. banana bag - though these aren't used too much anymore)Pts with chest tubes/drains must be outputting 100mls or less over 24hrs before clamping off tube6 Cardioprotective AgentsStatinsACE-I/ARBsHeparin/Lovenox (enoxaparin - an LMWH)ASA (aspirin)B-BlockersThrombolytics/TPAWhen dialysis patients get very itchy, its usually due to uremiaHypercalcemia can be secondary to malignancy - both solid tumours and leukemia10-20% of cases are due to this, especially Breast & Lung, and multiple myelomaOccurs through:osteolytic metastases w/ local cytokine releasetumor secretion of PTH-related proteintumor production of calcitrolProcrit (Epoietin) contraindicated in sickle-cell patients - does not differentiate between sickle cells and normal cells, so more of both are made (=bad!)In new-onset Type II Diabetes Mellitus, when trying to determine whether to start insulin or oral agents, use a fasting blood glucse of ~400 (mg/dL NOT mmol/L) as a barrierBelow, use oralabove, use insulin - but remember, insulin has side-effects!In pregnant DM patients, DO NOT use oral medications - insulin only!!When I/O is negative (down), you expect H&H to go up (less blood, more cells). If it goes down, check for active bleedingEsophageal Spasm, which can cause CP & mimics AMI symptoms can also be relieved by NTGAST + ALT in 1000's = Toxic (eg Tylenol OD)Normal AST/ALT with Increased Bili = obstructionNitrofurantoin (Macrobid)'s major side effect = Irreversible Pulmonary FibrosisIntracranial HYPOtension Triad:MRI showing sagging of the brainstemBilateral subdural hygromasDiffuse dural enhancementBronchiectasis (chronic infection of bronchi and bronchioles leading to permanent dilatation)Causes:Cystic fibrosisreccurent PNAimmunocompromiseMajor bacteria:Staph AureusPseudomonas AeruginosaAntibiotic most likely to cause C. diff infection - ClindamycinCan Flagyl (metronidazole - Rx for C. diff) cause C. diff? Yes.DVT's below the knee don't need treatmentPts on Metformin who are undergoing contrast studies need to hold Metformin for 48-72hrs after contrast administration, while monitoring BUN/CreatinineDo not enema/colonoscopy a pt with diverticulitis - you will perforate their bowels.And with that, I will leave it till next time (it's late, whatever). If you have any questions/clarification, feel free to comment (I feel like I haven't been getting enough comments lately :-D)-AMiB (Source: An American Medic in Britain)

Neonatal opioid withrdawal

An American Medic in Britain — Fri, 14 Sep 2007 21:45:00 +0100

3 day old AAM presents to the Emergency Room (at 2am) with agitation, excessive suckling, inability to sleep, etc. Upon further questioning of the Mother, we discover that during the last few weeks of the pregnancy, the mother was taking Percocet (and not small dose either, the 10/325 kind). Was discharged from the hospital today, fine.After a little while, baby starts having seizures, etc. Scored an 8 on the Neonatal Abstinence Scale (although the NICU nurses determined he was a lot worse than that). Admitted to NICU (Neonatal ICU) for Neonatal Opioid Withdrawal. Treatment is Supportive care, except in cases of seizures, inability to sleep, and some other things (forgot to write it down off UpToDate).Now, I'm not going to pass judgement on the mother or the condition of the baby...but, y'know, feel free to comment.-AMiB (Source: An American Medic in Britain)

"going to the er"

An American Medic in Britain — Thu, 13 Sep 2007 20:47:00 +0100

Part 1:http://www.youtube.com/watch?v=k9m2FLHlEwAPart 2:http://www.youtube.com/v/UM-HWkbnDfgThanks to ERnursey (Source: An American Medic in Britain)

So, it's been a while...

An American Medic in Britain — Wed, 12 Sep 2007 22:24:00 +0100

Well, I know it's been quite a while since my last post (which was featured in a Grand Rounds [only the second time I've submitted a post]). Things have been busy, I have been doing some steady 6-day weeks at the hospital and 5-6 day weeks at the gym. Am finishing up now, was in the ER today, have one more shift with the Hospitalists tomorrow as well as a night shift in the ER tomorrow and Saturday night. Then it's a few days of relaxation until my return to St. Andrews!Couple interesting things I saw today:86yo M on Coumadin bit his tongue 2 days ago, hasn't stopped bleeding since. Dr. M (female ER doc) puts a single 4-0 Vicryl (absorbable suture) in the hole, and applies some gauze. A little while later, patient has still not stopped bleeding, so we put some gel foam (little pieces soaked in thrombin/fibrin) to help the clotting...the bleeding slows, but the patient is poorly complaint (retired psychiatrist, Chinese - not much English) and it takes 3 things of gel foam and a small piece of surgicell to get it to stop. INR was only 2.0, btw.64yo F originally from Northern Ireland on Vacation, forgot both her insulin refills and her glucometer. Felt horrible (very compliant in past, never forgot insulin shots ever); we thought it would be an easy script, but turns out her sugar is 501. We give her fluids and some insulin, but she doesn't understand what 501 is. Then I realize - in the UK we do blood sugars in mmol/L, while in the US its mg/dL. So, here is something for all you guys out there who encounter this problem: 1 mg/dL = 0.0555 mmol/L. So if you find her BS to be 501, tell her it's 27. If she tells you she's normally 5-8, that means she's normally 90-144. Hope that helps!Today was also my last day shift in the ER...it always happens that I have to leave just when the nurses/techs/docs are getting used to me being around and are starting to feel more comfortable letting me talk to pt's, etc. Oh well, I've got years of that left.-AMiB (Source: An American Medic in Britain)

Nail guns...

An American Medic in Britain — Wed, 05 Sep 2007 22:47:00 +0100

Man working with nail gun.Man shoots nail gun (on accident) through great toe.Man admitted to hospital for surgical removal of foreign body and debridement.Always feels good to know that my profession is the one that fixes these people, not the one that it usually happens to. (Source: An American Medic in Britain)

Quote of the day, august29th, 2007

An American Medic in Britain — Thu, 30 Aug 2007 02:40:00 +0100

Patient is admitted for cardiac/renal problems. She is known to be very non-compliant (had a transplanted kidney from a family member that failed because she wouldn't take her meds), and Dr. S has had this pt before. Patient has a history of seizures. At discharge last time, Dr. S prescribed Dilantin (phenytoin), an anti-seizure medication.Dr. S: "Are you taking your Dilantin?"Pt: "No, doctor, because I stopped shaking..."Dr. S: "Who told you to stop taking your Dilantin?"Pt: "No one doctor, I just stopped"Dr. S: "You can't just stop taking your medication...especially ones for seizures"Pt: "But I'm not shaking anymore, doctor..."Me (in my head): "Yeah, you're not shaking anymore 'cuz you were taking Dilantin!"Dr. S: "Are you driving?"Pt: "Yes."Dr. S: "AMiB, go grab me a DMV reporting form"So people out there - if you want to stop taking your meds, no matter what kind, PLEASE, for our safety and yours, ASK your doc before doing so! (Source: An American Medic in Britain)

"code blue, 6west, back hallway"

An American Medic in Britain — Sat, 25 Aug 2007 00:16:00 +0100

So last night I was doing an overnight in the ER, and I had my first code of this summer. I've seen 5 or 6 in the past, and participated in 3 or 4, but this is the first one since I started at the hospital this June.Dr. M (ER doc), the ER tech, and I, all head out of the ER and towards the elevators. We are met there by 2 ICU nurses and 2 Respiratory Therapists. We get up to the 6th floor, and head to the 'back hallway'. As we walk through the nurses station, I'm completely surprised as to how empty it was. They must all be with the Code, I figured. And I was right. As we enter the hallway, I see a scramble of nurses, frantically doing things to save the old man on the floor. I ask for the story, and try and see his face to see if he was one of ours (on the Hospitalist service - he wasn't). He's had had a couple stents placed this morning, and had seemed to be doing fine. He was taking a walk (who goes for a walk at 3.15am?!) with his nurse, when he started to feel faint, brady'd down, and collapsed. No pulse, no respirations - so the Code was called. After a couple rounds of CPR and drugs, we get him onto a bed and into a room. It was then that I realized how many people respond to a code. Roughly 30 nurses, techs, CNAs, 1 doc (which should've been 3 - the ER, the Intesivist, and the patient's Cardiologist), and a handful of Respiratory Techs.I was standing outside at this point, and couldn't see much of what was going on. I did hear the patient, however: "GET OFF ME! YOU'RE KILLING ME! LET ME GO! LET ME GO!" (we were holding him still while trying to start an IV). These words were masking those of the Respiratory Tech: "Calm down, sir. Your heart stopped and we've had to CPR on you!"Eventually, he stabilized, and Dr. M went off to talk to the patient's Cardiologist. He didn't feel much like coming in to write orders, and wanted to send his NP to do it. Now, I have nothing against NPs, but if you're a Cardiologist, and you cath'd someone this morning, and they Code: come in. What about the patients family? It's your responsibility to let them know what happened. But anyway, I digress.By now, he's lost his pulse again. On with the compressions. We secure the airway with endotrachial intubation. The patient kept fluctuating between PEA, Asystole, and Brady, all the way down to the ICU. We get down there and continue compressions. Dr. M puts in a femoral arterial line to see if the compressions are working, as well as if the patient's heart is beating on its own.At 4.116am, roughly an hour after the Code was called, Dr. M pronounces the patient. The monitor is turned off, and everyone stops what they're doing. We look down at him, and see that his larynx is moving. Either he's trying to breathe on his own, or he's swallowing. Either way, that's not what a dead person does. We feel for pulses: one on each fem, one on each carotid. One of the ICU nurses swears she feels a pulse. Other people feel it as well, so we turn the monitor back on - but they don't match. It's much faster than what is on the monitor. I tell them to feel their own pulse while they're feeling the patients. Yep, those match. I guess it kind of goes to show how much health care professionals want to save their patients. We listen for heart sounds, check reflexes - nothing. His throat was probably just agonal breathing (last breaths).Time of Death, 4.20am. (Source: An American Medic in Britain)

Quote of the day, august 23rd, 2007

An American Medic in Britain — Thu, 23 Aug 2007 23:21:00 +0100

So there's this Infections Disease doc, Dr. C. The Hospitalists hate the ID guys, cuz they interfere with our antibiotic treatment and blocking discharges of patients who really should be going home. Anyway, I've NEVER seen Dr. C, but I always see her notes in our charts. For a while, I didn't believe she actually existed. Figment of our imagination, I believed. In reality, she rounds late at night, because her notes are always timed no earlier than 2200 (once, she had put 2430 - because they have to see each patient and write a note each day).Anyway, today I actually met her. She looks up at me and asks me to question I get so many times -Dr. C: "So, are you a new Hospitalist?"Me: "No, I'm just a Medical Student"Dr. C: "Oh...you're awfully big for a medical student"wtf?! (Source: An American Medic in Britain)

15 hours?

An American Medic in Britain — Sat, 18 Aug 2007 18:47:00 +0100

So I just spent the past 15 hours in the ER...I think I coulda pulled off the full 18 hours (2 9-hour shifts with 2 different docs), but my parents don't take too kindaly to being gone for 18 hours at a time so I came home...I really learn alot, and while the doc takes the history, I have started trying to guess their next question (which i'm horrible at) but also what tests they are going to order. I seem to always miss one or two big ones, but hopefully with time I'll get better.Now please excuse me while I sleep for an unknown length of time. (Source: An American Medic in Britain)

Oh, how i miss it down here...

An American Medic in Britain — Fri, 17 Aug 2007 02:33:00 +0100

So ever since Dr. M (ER doc) gave up his overnight shifts, I've only been able to do 2 shifts a week with him in the ER. For a guy who has a semi-secret desire to be an ER doc, this is not enough. So tonight and [hopefully] tomorrow night, I will be doing some overnight ER shifts with Dr. M (a different one, who happens to be the only lady ER doc that we have). It should be exciting, especially since tomorrow is Friday night, and we're a Level II Trauma Center, meaning we get all the drunk fights and car accidents for 1/4 of our city.Bring on the energy drinks!-AMiB (Source: An American Medic in Britain)

An example of poor doctor-patient interaction...

An American Medic in Britain — Wed, 15 Aug 2007 06:43:00 +0100

http://www.ctrlaltdel-online.com/comic.php?d=20070815 (Source: An American Medic in Britain)

Quotes of the day, august 14, 2007

An American Medic in Britain — Tue, 14 Aug 2007 22:59:00 +0100

Cardiothoracic Surgeon's NP: "Ugh, I can never get any nurses on that floor to answer their phones!"Secretary: "What happened?"NP: "Well this time, I got transferred to another nurse because the nurse I wanted to talk to was stuck in a Code Brown!"Me: *stupidly looks down at badge, flips through different codes; finds no Code Brown* "What's a Code Brown?"Dr. A: "Hahaha, you've never heard of a Code Brown?"Me: "Noo..."NP: "I'm going to let you figure that one out by yourself."Me: "ummm....OH!" *face-palm*NP: "It took you that long? Are you sh*tting me? ;-)" (Source: An American Medic in Britain)