MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'i'm so sleepy' source. Mon, 22 Dec 2008 13:06:27 +0100 http://laryngoscope.blogspot.com/2008/11/platelet-shortage.html Interesting email this week:This is a reminder that Thanksgiving is next week. We anticipate severe platelet shortages for the first week of December. Platelet availability will be VERY tight December 1-4. Monday and Tuesday will be the worst days since there will be virtually no blood donations Thursday-Sunday. If you have elective surgeries with high anticipated platelet needs, I would recommend rescheduling for the following week. I guess I never thought of that, but it makes sense.Platelet availability is dependent on recent (last 4-5 day) platelet donations. The week immediately after Thanksgiving and the Christmas-New Year holidays are always characterized by platelet shortages due to low whole blood donations in the preceding week. (Source: i'm so sleepy) i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=1984799 Mon, 24 Nov 2008 20:19:00 +0100 1984799 http://laryngoscope.blogspot.com/2008/11/morning-surprise.html You think you're going to have a relatively quiet day... 2 thoracic rooms, only 2 casesone room is a late start, so no having to try to start two rooms at the same time.Come in... pull up the computer to double check the patient's histories...Hmmm... double lung transplant.*sigh* it's a living (Source: i'm so sleepy) i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=1947115 Mon, 10 Nov 2008 15:18:00 +0100 1947115 http://laryngoscope.blogspot.com/2008/10/dirty-car.html Image from Wikimedia Commons Original Batmobile copyright ABC-TV and DC comicsOne of the cardiac surgeons always has the dirtiest car in the lot (He must live on a dirt road or something. We were there on the weekend and he mentioned that he's going to have to find out who wrote something in the dirty back window with their finger.What did they write on the window of the surgeon who does the most tranpslants/VADs(ventricular assist devices) at our hospital?VADMOBILEHilarious... (to me anyway) (Source: i'm so sleepy) i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=1847911 Fri, 03 Oct 2008 09:40:00 +0100 1847911 http://laryngoscope.blogspot.com/2008/08/web-logs.html Occasionally I go through my counter logs to see how people get to my blog. I try to add links to blogs that link to mine, etc.I use the free version so it doesn't tell me much. But there's some interesting stuff.Links from several other medical blogsMany google searches for things:Some medically related stuff, especially related to anesthesia"abdominal surgery" "cooling down on pressors medication" "scar tissue sternum" "difficult airway box""what does it mean when a doctor says a pt is a very poor historian"see 7/16/2007 Poor historianPeople who are sleepy"i'm sleepy" "I'm sleepy the entire day" "How not to be so sleepy" "at work so sleepy" "I'm at work and so sleepy" "Why am I so sleepy" "I'm sleepy what to do" "why am i so sleepy all of the time" "im so sleepy all the time why is this"... i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=1711738 Sun, 17 Aug 2008 12:40:00 +0100 1711738 http://laryngoscope.blogspot.com/2008/08/gah.html Don't want to talk about the exact incident.When I supervise residents or CRNAs I am responsible for their actions......regardless of whether or not I am aware of them.The case was managed correctly.I didn't know about significant blood loss until I was informed by another anesthesia provider.Wouldn't have done anything different, would have liked to know about it. (Source: i'm so sleepy) i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=1696133 Sun, 10 Aug 2008 19:19:00 +0100 1696133 http://laryngoscope.blogspot.com/2008/07/helpless.html On Saturday I was at a popular nationwide-chain arcade/restaurant/bar and playing around trying to win enough tickets to get a stupid little trinket.I heard a bit of a commotion. Apparently a young girl fell to the ground off a seat and her mom and little brother were screaming and crying (respectively). I rushed over because it didn't look like anyone was really helping (though there was a small crowd gathered). The girl seemed unresponsive.... I felt for a pulse and put my ear to her back to see if she was breathing... she was. I asked the mother what happened... she said it looked like she had a seizure, though she was a healthy kid and never been sick in her life. I made sure someone had called 911 and really didn't know what to do next. I'm pretty used to dealing with rough situations... i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=1563858 Wed, 02 Jul 2008 15:54:00 +0100 1563858 http://laryngoscope.blogspot.com/2008/06/time-out-day.html Image taken without permission from Benches.comApparently it's National Time Out Day...No we don't have a bunch of rowdy 6-year-olds in the hospital (though it seems that way sometimes)It's a partnership of the Council on Surgical and Perioperative Saftey and the Joint Commision, and other organizations such as the American Society of Anesthesiologists and the Association of periOperative Registered Nurses, among other groups to improve safety in the operating rooms and prevent wrong site and wrong side surgery. (There have been several tragic cases of the wrong limb being amputated... etc. gah!)For some reason National Time Out Day was June 25th in 2004, June 22 in 2005, June 21 in 2006 and June 20 in 2007. Really it's National Time Out Day-somewhere-in-middle-to-end-of-June. Guess you co... i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=1526091 Wed, 18 Jun 2008 12:15:00 +0100 1526091 http://laryngoscope.blogspot.com/2008/05/epidural-testing.html I put in a thoracic epidural with a resident yesterday. Epidurals are small catheters that go into the space right outside the spinal cord. We give local anesthetic solution through them and it numbs up portions of the body. They are useful for controlling surgical and labor pain. We test them to make sure they are working well. One way is to use a piece of ice and see if the patient can feel the coolness. The other is to use a "sophisticated testing device" called a toothpick to see if they can feel pain sensation.We finished putting in the epidural and I asked the resident to test the patient. She was testing areas and the patient was amazed that she could not feel the toothpick at all..."Give me that..." she grabbed the toothpick and started jabbing herself in the side. "Wow" Somehow sh... i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=1418430 Sat, 03 May 2008 10:06:00 +0100 1418430 http://laryngoscope.blogspot.com/2008/03/helicopter.html I hear helicopters in the background. Not so long ago, as a child, I often looked up in excitement at the incredible speed, power and agility of such magnificent machines. Now more often than not (even when I'm not at work) I hear that engine noise and I think... work (Source: i'm so sleepy) i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=1280709 Wed, 05 Mar 2008 16:20:00 +0100 1280709 http://laryngoscope.blogspot.com/2008/03/soaked-to-skin-iii.html Now to help the patient you have to relieve the pressure around the heart. Usually this is (relatively) easy. You use a sternal saw and cut through the sternum. (middle of the chest where the ribs come together).In this case it was more difficult. He's had cardiac surgery before. Which means they've already sawn (sawed?) through his sternum in the past. This is problematic because there's sometimes lots of scar tissue there now, so if you try to get in through the sternum quickly, you make have to go through scar tissue. And in that scar the patient's aorta, which is the biggest artery in the body, may be scarred together. The other option is to go in through the side of the rib cage. Since he hadn't had any surgery on his chest from the side, there's less chance of scar tissue and bleedin... i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=1270538 Sat, 01 Mar 2008 12:48:00 +0100 1270538 http://laryngoscope.blogspot.com/2008/02/soaked-to-skin-ii.html anyway, sorry for the delay.. where was I...So they're doing CPR on the patient. I went up to the anesthesiologist and asked what was going on. Apparently they were doing an ablation in the ventricle and they had starting getting low blood pressure during the case, then a cardiac arrest.Now you see some people have irregular rhythms in their hearts. Usually these are cause for little areas of abnormal tissue in the heart, they can burn these areas and usually the irregular rhythms will go away. This is called an ablation. Sometimes they burn through too much and they can get into trouble. It's known to happen, but usually rare.The problem they have here is now they have a hole in the heart and it starts to bleed. That in and of itself isn't great, but the main problem is that the heart sit... i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=1240171 Mon, 18 Feb 2008 22:54:00 +0100 1240171 http://laryngoscope.blogspot.com/2008/02/soaked-skin.html As an anesthesiologist you shouldn't need to go to your office and change your scrubs in the middle of a case.No I didn't soil myself because the case scared the heck out of me because it did, but I was covered in blood from moving the patient on to the bed.I'm on call today and I was headed down to the Electropysiology (EP) lab to relieve the anesthesiologist down there so he could go home. I'm poking around looking to find out which room he's in. I pop my head in one room, I see a CRNA... have you seen Dr. X? Oh he was just here but he's probably next door... they're having trouble.Hmm... that's not a good sign. I go into the room and usually the room is dark and quiet, the patient is on the bed under light sedation... they're usually pretty sick, but generally unexciting. Anyway... I go... i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=1216486 Thu, 07 Feb 2008 23:41:00 +0100 1216486 http://laryngoscope.blogspot.com/2008/01/stat.html "Staff Stat to OR Z"Hmm.... not good. usually.This is an alarm system we have so if there's anesthesia emergency and the staff is not in the room, the resident or a nurse can call overhead on the speakers and everyone available can come to the room to help whomever is in there.Sometimes it's only a false alarm, the patient's oxygen level is reading a little low and the resident gets a little worried.Sometimes it's much worse."Staff stat to OR Z"I shuffle quickly over there.I walk in, they are doing chest compressions. Apparently the patient "crashed" about 10 minutes after the start of the case.... low blood pressure of uncertain origin, didn't improve with treatment at all so they started CPR (Cardio Pulmonary Rescusitation). Emergency drugs were given.... epinephrine, atropine, all the g... i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=1187119 Tue, 29 Jan 2008 15:40:00 +0100 1187119 http://laryngoscope.blogspot.com/2008/01/computers-down.html Went to a doctors appointment today. I usually go at 8am. The doctors tend to run behind and if I'm the 1st patient of the day they can't be behind. Anyway, the doors are usually unlocked at 7:45 or so. I pull up and there are three or four people milling around the door. At about 8 they open the door. I walk in and try to check in. Apparently the computers and phones were down. They couldn't check me in, they couldn't put me in a room. Fifteen minutes later, they put me in a room and found some forms to manually check me in. The doctor comes in a few minutes later, he's obviously flustered.How are you doing? Did they check your sugar today? No of course not, the computer would have told them to do that. Sorry we have no chart, we're all paperless now. What was your last Hgb A1C? your memo... i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=1160980 Fri, 18 Jan 2008 12:47:00 +0100 1160980 http://laryngoscope.blogspot.com/2007/12/sick.html It's that time of year again. Time for flu, colds, etc.I was in charge of making sure rooms in our building were assigned to residents and faculty the other day. This includes assigning where add on cases go and making sure people get breaks and lunches and relieved at the end of the day.One of the residents came up to me and told me he might need extra breaks because he's been having some "GI (gastrointestinal) problems" and been running to the bathroom. He said he was probably going to the emergency room after work because it had been going on for five days or so.Yikes! A few minutes later his faculty came up to me and said his resident looked terrible and diaphoretic (sweaty) and should be sent home. I agreed and called over to the main building to see if there was someone extra to send... i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=1082867 Mon, 10 Dec 2007 03:27:00 +0100 1082867 http://laryngoscope.blogspot.com/2007/11/shock-of-your-life.html Image used without permission from freepatentsonline.comI'm staffing a case down in the Electophysiology (EP) lab. Here is where the cardiologists look at the heart from the inside and do various procedures to help fix conduction abnormalities in the heart. They implant defibrillators and pacemakers in the EP labs. There was a young man on the table, we were getting ready to sedate him for a procedure for an irregular heartbeat. Our anesthesia monitors were being put on and I was looking at the chart. All of a sudden I saw the patient jump up... I thought he was trying to crawl off the bed. Then someone started apologizing....Apparently she was testing the external defibrillator. This is the device used to put a shock through a patient's chest to put it his/her heart back into a regular rh... i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=1047562 Fri, 23 Nov 2007 15:45:00 +0100 1047562 http://laryngoscope.blogspot.com/2007/10/neck-mobility.html I was in preop anesthesia clinic yesterday. I saw a patient that had been in a car accident and had his neck fused c2-c5 (I believe) and he had very little neck movement at all.In anesthesia there are markers to predict or at least suggest it may be difficult to place a breathing tube in someone. These include mouth opening, dentition, mallampatti score, which assesses the favorablity of the anatomy of the oral cavity (i.e. mouth), hyoid to mentum distance (essentially chin size), neck thickness/anatomy, neck extension and flexion. No one predictor predicts a difficult intubation, but together they form a picture of how easy or difficult you think it might be.Someone with very limited neck movement would be very difficult to visualize the vocal cords generally, so I was worried a bit in th... i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=947297 Fri, 12 Oct 2007 13:50:00 +0100 947297 http://laryngoscope.blogspot.com/2007/10/perioperative-guidelines.html Got sent the new ACC/AHA revised perioperative cardiovascular guidelines for non-cardiac surgery. It was a PDF attached to my email, and I figured I should know what's in them since I work in the preop anesthesia clinic, so I printed them out...what could it be... ten pages maybe...nope.I went to the printer and it was still printing and it was neverending.82 pages!Yikes... I know it's a complex topic, and I need to know them. 6 pages down... 76 more to read... i think some of them are references though... maybe only 70 pages... (Source: i'm so sleepy) i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=944529 Thu, 11 Oct 2007 13:42:00 +0100 944529 http://laryngoscope.blogspot.com/2007/10/hand-sanitizer.html Image used without permission from childrenshospital.orgJust got a message on my pager.I accidentally contaminated the sterile field with [brand deleted hand sanitizer] ( that went out of control) --[resident name deleted] Our hospital has gone to having alcohol based hand sanitizer everywhere, to decrease the spread of infection... there's one on the side of the anesthesia cart. Apparently, the spout had gotten clogged a bit and when she went to pump some on her hands it squirted sideways and hit two people scrubbed-in and the corner of the instrument table... and we're doing a descending thoracic aneurysm repair and they're often super-paranoid (rightfully) so that the artificial graft material doesn't get infected.Didn't seem the surgeon had flipped out though... probably due to the fac... i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=925251 Wed, 03 Oct 2007 13:28:00 +0100 925251 http://laryngoscope.blogspot.com/2007/09/locked-out.html I was on call yesterday and there was a fire drill going on so the fire alarms were going off... i was headed to the ORs to wake up a patient with one of the residents and I swiped my ID at the OR doors... Nothing... no click, just blinking lights on the pad. I swiped my ID again. Same. So I pulled on the door. still locked no way to open it. Luckily someone was exiting the locker room and I got in there and cut into the ORs. This happened on one other occasion with a different door soon after the opening of our new addition, which I chalked up to being in a new building. I don't know if this is the case with any other doors, but I'm guessing it is.This is a serious problem. Luckily I was going to a routine wake-up with a good resident and I wasn't really needed. But we need to get into t... i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=909365 Fri, 28 Sep 2007 09:46:00 +0100 909365 http://laryngoscope.blogspot.com/2007/09/fat.html Wow. One of my rare days now where I'm not doing cardiac or thoracic cases.The patient had a Body Mass Index (BMI= weight in kg/ [height in meters]squared) of 78! Overweight is above 25, obese above 30. It's a little conservative in my opinion, but this is ridiculous. He was 5 foot 6 or so, and above 220kg. (~500 lbs) fortunately he was here for gastric bypass surgery.When they're this big, you worry if you're able to get IV access, establish the airway, and whether the surgeons will have difficulty with the procedure.Luckily no problems.I did have salad for lunch... I need to work on my own BMI. (Source: i'm so sleepy) i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=896018 Mon, 24 Sep 2007 19:39:00 +0100 896018 http://laryngoscope.blogspot.com/2007/09/sad.html I pulled out my bike from the garage yesterday to ride it to the gas station to get some air for the tires... It's about two miles I guess. Anyway, I was recounting this to my girlfriend who seemed glad I was getting some exercise. "Well it took you about 30 minutes... that's not too bad.""Minus stopping for air...""You were that winded?""... Air... for the tires."I must be more out of shape than I thought. (Source: i'm so sleepy) i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=880132 Tue, 18 Sep 2007 14:09:00 +0100 880132 http://laryngoscope.blogspot.com/2007/09/poop.html Luckily my friend's dad is feeling a bit better... kicked out of the hospital. No more obsession with flatus. Now family is obsessed with poops. (Source: i'm so sleepy) i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=848286 Fri, 07 Sep 2007 01:34:00 +0100 848286 http://laryngoscope.blogspot.com/2007/09/abdominal-surgery.html My friend's father had emergency bowel surgery this past weekend, so I've received many surgical type questions which I'm marginally qualified to answer. In any case I'm finding it amusing with how my attention is being taken to his gastrointestinal tract, specifically the ability to pass gas. Hope he's feeling better soon. (Source: i'm so sleepy) i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=840508 Tue, 04 Sep 2007 13:39:00 +0100 840508 http://laryngoscope.blogspot.com/2007/07/mini-mall.html Ever heard of grand mal seizures? It's the type of seizures most think about as seizures, with unconsciousness and violent jerking movements.I'm in clinic today. On her history form she has written "mini mall seizures".I usually shop at mini-malls, but I think she means petit-mal seizures. These are also known as absence seizures and not associated with jerking motions. (Source: i'm so sleepy) i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=762982 Fri, 27 Jul 2007 19:54:00 +0100 762982 http://laryngoscope.blogspot.com/2007/07/poor-historian.html I'm in clinic again... the bane of the non-pain anesthesiologist. A 60-some year old woman is here for surgery. She's had a history of heart failure. (Her heart is damaged so it doesn't pump very efficiently) She's a terrible historian.Now for non-medical types, this doesn't mean she didn't know that Washington crossed the Delaware. It means that she's a terrible reporter of her own medical history. For different patients it means different things. To some it means that they can't remember what they've had done in the past or what medical conditions they have. To others it means that they ramble on so much it's hard to separate the medical information from random stories about their puppy. And my favorite group is the group where they're so vague about things that it takes 14 follow-up que... i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=736265 Mon, 16 Jul 2007 10:35:00 +0100 736265 http://laryngoscope.blogspot.com/2007/07/study-says-chatty-doctors-forget.html Study Says Chatty Doctors Forget PatientsFunny... except for the patients. Published in the Archives of Internal Medicine via the New York Times (Source: i'm so sleepy) i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=710257 Mon, 02 Jul 2007 17:45:00 +0100 710257 http://laryngoscope.blogspot.com/2007/07/playing-doctor.html I got to play "real" doctor this weekend.Not that an anesthesiologist isn't a real doctor, but it's not immediately what comes to mind when you say doctor.My friend volunteers at a free county medical clinic run by medical students some weekends. The medical students see patients and are staffed by physicians from the community. They were running short of physicians this week so I offered my services.It was a little different than my usual Saturday morning, but a little fun nonetheless. I only had to ask a few questions to the "real" doctors.A lot of me saying to medical students "just warning you... I (Source: i'm so sleepy) i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=707848 Mon, 02 Jul 2007 03:46:00 +0100 707848 http://laryngoscope.blogspot.com/2007/06/staffing-shortage.html This week we opened a new building... brand new operating rooms, new offices, etc. beautiful place. Still some growing pains as we are somewhat short staffed.Yesterday, we had an urgent case to start. No residents or CRNAs were available since it was a lecture day and the available people were giving breaks so other people could go to their lectures.Anyway they had an available OR, and I myself was giving lunch breaks....So I just went ahead a did the case myself.I know this doesn't sound too strange to most of you. It's probably the norm in most places. But being at an academic institution I haven't done a case by myself, well ever. In the few years I've been staffing, I always work with a resident or CRNA. Before then I was a resident so I worked with a faculty member supervising me.It's... i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=675017 Thu, 14 Jun 2007 23:07:00 +0100 675017 http://laryngoscope.blogspot.com/2007/06/preop-hijinks.html So I'm in clinic today and I'm talking to a patient about his health problems for some surgery or another. All of a sudden he stands up, unbuckles his belt buckle, unzips his pants and starts tucking his shirt in. Now I've done this before too, but usually it's in my bedroom before I go to work or if I'm in the bathroom or if I'm alone somewhere with no hope of someone walking in.Weird and unsettling.I just acted like nothing was happening and averted my gaze. (Source: i'm so sleepy) i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=675018 Tue, 12 Jun 2007 20:48:00 +0100 675018 http://laryngoscope.blogspot.com/2007/06/condolences.html As you no doubt have heard by now. A plane with an organ transplant team crashed into Lake Michigan on Monday. All six aboard were lost.Condolences to the families of the two doctors, two organ donation specialists, and two pilots.They perished in the quest to save the life of another. (Source: i'm so sleepy) i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=675019 Wed, 06 Jun 2007 17:49:00 +0100 675019 http://laryngoscope.blogspot.com/2007/06/tragedy.html I don't really want to talk about it now but do me a favor.Go home, kiss your wife or husband, boyfriend or girlfriend, hug your children. You never know when it's the last time.More later... maybe (Source: i'm so sleepy) i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=658745 Tue, 05 Jun 2007 00:16:00 +0100 658745 http://laryngoscope.blogspot.com/2007/06/tuberculosis.html Everyone knows the name of Andrew Speaker. If you don't he's the person carrying the multidrug resistant tuberculosis(TB) stain all over the world. First, Tuberculosis. It's a difficult disease to treat... months of antibiotics are required in most instances, and usually more than one type of antibiotic. Because people generally feel fine when they have this diagnosis they often quit taking the medication. This leads to more drug resistance.I find a few things very funny about the case. 1. He's a personal injury lawyer. If someone else had done this I bet he'd be on TV advertising for people to call him to get their "rightful settlement"2. His new father-in-law... works for the Centers for Disease Control. Speciality -- tuberculosis. You can't make this stuff up.3. His name came up when he... i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=654396 Sat, 02 Jun 2007 15:08:00 +0100 654396 http://laryngoscope.blogspot.com/2007/05/keywords.html So I've realized for the last few posts that you can add keywords to each post and people can read those posts with those keywords only.I'm anal enough that I'm going back and adding keywords to all my old posts. Hope this makes reading more enjoyable.(I'm assuming people are reading) (Source: i'm so sleepy) i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=650751 Thu, 31 May 2007 13:51:00 +0100 650751 http://laryngoscope.blogspot.com/2007/05/random-walls.html Image from freefoto.com I'm walking out of work late yesterday. I'm tired. I'm on cardiac call i've been here for 12 hours. Not bad hour-wise but i've had to work with one of the stressful surgeons and just finished helping code a patient in the operating room.I just want to go home and put up my feet...All of a sudden there's a wall along the corridor where I usually walk out. It was open this morning "Detour -->" I guess they're finally connecting the new building to the old one.Now I wander through the basement and finally get to my car.Perfect ending to a long day. Hope I don't get called back in. (Source: i'm so sleepy) i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=644782 Wed, 30 May 2007 13:34:00 +0100 644782 http://laryngoscope.blogspot.com/2007/05/yay.html I got a page from a friend today saying oral board results were posted.I passed!It's about a week and half earlier then they said scores would be up, but I'm glad.Relief. (Source: i'm so sleepy) i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=611719 Fri, 11 May 2007 04:02:00 +0100 611719 http://laryngoscope.blogspot.com/2007/04/oral-boards-done.html I've been back from DC. Oral boards are done.Yay!Topics were anticipated. Did I study enough, hard to say... would studying more been more helpful... doubtful.I think I did okay... but who knows for sure. I'll find out at the end of May.At least it's over, for now. (Source: i'm so sleepy) i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=567956 Wed, 25 Apr 2007 03:27:00 +0100 567956 http://laryngoscope.blogspot.com/2007/04/transvaginal-cholecystecytomy.html In a word -- Yuk! These words together mean removal of the gallbladder through the vagina. Yuk yuk yuk.If I had a vagina, you're not removing my gallbladder through it.And to boot there's a Natural Orifice Surgery Consortium for Assessment and Research. You can leave my natural orifices alone... I mean look what great scientific advances there are in this decade.New York Times online via Book of Joe (Source: i'm so sleepy) i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=564294 Tue, 24 Apr 2007 02:18:00 +0100 564294 http://laryngoscope.blogspot.com/2007/04/dc-in-spring.html Ah to be in Washington DC in the spring.Blossoms on the trees.Spring is in the air...NO!I'm in DC for anesthesia oral board examsIts 40 degrees outside. There's a wind advisory...The plane was shaking like a laundry dryer as we were landing... and I swear we were going sideways for several seconds.AND I'm taking oral boards tomorrow.I'm a little stressedI'm back to the books for last minute cramming... maybe a short nap.More later. (Source: i'm so sleepy) i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=547279 Mon, 16 Apr 2007 19:15:00 +0100 547279 http://laryngoscope.blogspot.com/2007/03/drug-interactions.html A friend called and asked me: "Are there any drug interactions between Darvocet and albuterol?" Her friend had just had surgery and was on pain killers (Darvocet - acetominophen/proproxyphene) and wanted to take a puff on her inhaler (Ventolin- albuterol).I said I didn't think so. The narcotic has lots of interations, but not likely with albuterol. "Why?" I asked."Well she saw this Law and Order where this girl poisoned her mom with darvocet and albuterol."Hmm... Law and order? "You sure that wasn't darvocet and ALCOHol not ALBUTERol?""Hmm... yeah probably, see ya bye!"I guess it's all in the details. (Source: i'm so sleepy) i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=469747 Tue, 13 Mar 2007 01:29:00 +0100 469747 http://laryngoscope.blogspot.com/2007/02/clinic.html Been in clinic a lot the last few weeks. Almost half my work time. By now i'm almost suicidal... I didn't go into anesthesia to do so much clinic(no offense to those who are actually suicidal) (Source: i'm so sleepy) i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=464382 Mon, 26 Feb 2007 19:43:00 +0100 464382 http://laryngoscope.blogspot.com/2007/01/room-temperature.html It's important to keep the patient in warm in most cases. Most cardiac cases this is not an issue much because the heart-lung bypass machine has a heat exchanger on it which allows the perfusionist to warm or cool the (patient's) blood as it goes through it.We were doing a big cardiac case under left heart bypass -- where part of the blood is taken after it gets passed through the lungs, and rerouted to the femoral artery in the groin so that work can be done to the descending aorta with most of the blood flow being perserved. This is nice so that damage to important organs like the kidneys and intestines can be limited.Since we have less control over temperature because it's only partial bypass, we had the room temperature way up. It was warm for me, but must have been killer for the surg... i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=464383 Sun, 14 Jan 2007 14:56:00 +0100 464383 http://laryngoscope.blogspot.com/2006/12/working-too-hard.html Imagine my suprise to get my schedule this month to find that I have 3 random vacation days this week. Apparently I'm not using my vacation fast enough. I got some Christmas shopping done, and put up some decorations.Brr. (Source: i'm so sleepy) i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=464384 Tue, 05 Dec 2006 23:11:00 +0100 464384 http://laryngoscope.blogspot.com/2006/11/sexily-dressed-doctors-may-be.html My resident in clinic showed me this article today from the ABC news web siteSexily dressed doctors may be dangerousFirst of all, it must be a slow news day. Second of all the first paragraph mentions Grey's anatomy. And we know that all hospitals are like the hospitals on TV.Sad. (Source: i'm so sleepy) i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=464385 Wed, 22 Nov 2006 18:01:00 +0100 464385 http://laryngoscope.blogspot.com/2006/11/day.html Been gone for a while, busy at work, vacation (wasted nothing too fun), then busy at work sorry there's been not much posting.Put in a LVAD (left ventricular assist device) in a patient, which is an assist device to help the left side of the heart. Another patient had an RVAD which was a device to help the right side of the heart which we took out. Stressful day though... now doing some general cases while the overnight guy does a heart... what a way to make a living. (Source: i'm so sleepy) i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=464386 Thu, 09 Nov 2006 02:58:00 +0100 464386 http://laryngoscope.blogspot.com/2006/09/high-glucose.html my fasting glucose this am was high, 167 usually it's been running high but only in the one-teens to 120s 3 confounding factors.1)I was up all night teeing up a heart transplant2)I'm using a different glucometer, the one at work, rather than my usual at home3)I had Chinese takeout for dinner.Sadly i suspect It's number three. (Source: i'm so sleepy) i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=464387 Mon, 04 Sep 2006 12:10:00 +0100 464387 http://laryngoscope.blogspot.com/2006/08/being-patient_30.html So apparently I have diabetes. I went innocently enough to the doctor's office to ask about getting a sleep study for sleep apnea (which I probably have). So he's asking all these questions and running all these tests because it's the first time I've gone to the doctor's in years. My Hemoglobin A1c was through the roof. The hemoglobin A1c measures the average blood sugar over the last 120 days or so in your blood. Also I had a pretty high blood pressure in the office.Now I'm checking my glucose (almost) every morning, supposed to be checking my blood pressure regularly so he can decide if I need an anti-hypertensive medication. My sleep study is scheduled, and I'm making calls to the insurance company to see if things are covered. I guess I'm a set up for this. Even though I'm in my early ... i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=464388 Wed, 30 Aug 2006 16:46:00 +0100 464388 http://laryngoscope.blogspot.com/2006/08/black-cloud.html (Sorry that postings have been so sparse. I'll fit in more time)Some say that I have a black cloud. They're wrong. I have a storm cloud following me. Let me clarify. In the medical profession, (I don't know if this concept exists in other fields) if you attract all the worst, bad, complicated cases, or when you're on call everyone and their mother has to come to the hospital, then you have a black cloud. It's possible to have a white cloud. And sometimes the white cloud cancels out the black cloud. Anyway, I think the origin of my black cloud was my first day of residency. To sum it up... out of the 2 patients I took care of that day, half of them did not live to see the next day. Not that I was responsible, but it was still traumatic nonetheless. I had patients die the first two times I w... i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=464389 Mon, 14 Aug 2006 01:22:00 +0100 464389 http://laryngoscope.blogspot.com/2006/07/tee.html Sorry it's been a while. I've been on vacation for three weeks... but it's not really a vacation because I've been studying for anesthesia boards (third time around.. yikes, wish me luck)Anyway I was watching Discovery Health (flipping past really... I rarely WATCH it) and there was a cardiologist talking about a test they "rarely" do in the ER. A TEE. A TEE stands for TransEsophageal Echocardiogram. Break it down -- basically a picture of the heart using soundwaves with the probe being in the esophagus (your feeding tube) Then they have the patient talking about it and him being scared and they show a picture of a medical instrument and you're supposed to assume it's a TEE.BUT IT'S NOT!!!They show what is probably a gastroscope -- a camera used to see into your stomach. And I can guess wh... i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=464390 Sun, 09 Jul 2006 03:50:00 +0100 464390 http://laryngoscope.blogspot.com/2006/06/sixteen-kids.html Just got done watching a bit(most) of a show on Discovery Health called "On the road with 16 children." It's about a family vacation of a family with 16 children.... that's a lot of kids! It's interesting, but I'm uncertain of why it's on the "Health" channel. (Source: i'm so sleepy) i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=464391 Mon, 12 Jun 2006 05:17:00 +0100 464391