At term
- Blood volume increases by 50%
- increased uterine blood flow 500-800ml/min
- uterus recieves 10-15% cardiac output
Monday, April 29, 2019
Cardiovascular changes in pregnancy
Sunday, April 28, 2019
Internship dairies: Finding a vein
So here's a quick post in support of Internship Diaries. I would like to give you advice on how to do blood draws and insert IV lines.
First of all, learn properly before you try it on another human being. Watch YouTube videos, learn by observing.
Second, the tourniquet is your friend. If you don't have a tourniquet, use a glove instead. It will make the veins more plump.
Third. Feel the vein before you attempt to insert the needle or cannula. FEEL IT.
Be patient and take your time. It's better to spend 30 seconds extra than to poke somebody and spend five minutes more trying to find a vein.
I know that this is phlebotomy and nursing advice and it may not be needed in hospitals where the ancillary staff does it.
But hey, hope this helps! :)
PS: I just realized I've written a longer post before here: https://www.medicowesome.com/2015/10/tips-on-how-to-find-vein-or-phlebotomy.html
-IkaN
Strabismus/Squint
Strabismus has been confusing me for long, so I decided to come up with a chart:
You can download the chart at https://drive.google.com/file/d/1leP_Ir3FZU0J-0isZcYHkgd5x_ujQFX8/view?usp=sharing
Thanks!
Chaitanya Inge
Upasana Yadav
Saturday, April 27, 2019
Propofol infusion syndrome
Hello friends!
It is the triad of metabolic acidosis, skeletal myopathy and acute cardiomyopathy.
It is seen in children on prolonged infusion.
It occurs due to failure of metabolism of free fatty acids.
Madhuri.
Propofol
Hi friends!
Propofol is a non-barbiturate intravenous anesthetic agent.
Colour : milky white liquid.
Chemical name : 2,6-diisopropylphenol.
Composition: soyabean oil, glycerol and lecithin.
Metabolism:70% in liver, 30% in lungs and kidneys.
Propofol is associated with quick recovery. So it is the drug of choice for day care surgeries.
Systemic effects:
CVS : It decreases systemic vascular resistance leading to fall in blood pressure causing tachycardia. But it actually causes bradycardia. The reason being blunting of carotid body receptor response (which we have studied in our physiology)
RS : It causes maximum depression of upper airway reflexes. So it is the drug of choice for insertion of laryngeal mask airway.
CNS : It causes cerebral vasoconstriction leading to fall in intracranial pressure. It is an antiemetic, antipruritic and antioxidant.
It is an anticonvulsant but may cause involuntary movements.
Thanks for reading!
Madhuri.
Massive blood transfusion strategy
In patients with massive haemorhage with a loss of more than 40% of blood volume - rapid transfusions are given with colloids, crystalloids and packed RBCs.
This causes coagulopathy by diluting the a clotting factors.
Hence, prophylactic infusion of platelets and fresh frozen plasma is done.
Initially, it was given in a ratio of 1:1:4
One part platelet & ffp transfusion to every 4 bags of blood.
It has been renewed now to 1:1:1 ratio
It has caused significant reduction in mortality 40% versus 60%
Thank you!
40% blood loss translates to grade 4 hemorrhagic shock or grade 1 degree of urgency per the urgency grid for obstetric hemorrhage. I removed the grading in the initial part of the post to avoid confusion as different grades mean different severity of shock based on the scale used.
- sakkan
EPISODE 01 INTERNSHIP DIARIES - (The best way to FINISH is to START first!)
“Hello Dr. Kesh” She looks back at you.
“Omg!” You think. “This is it! People are calling me doctor now! Yoohoo!” you smile widely.
****
Dr. Wen is a helpful young doctor in his late thirties who happens to be the Chief Resident of Internal Medicine. His orientation on the hospital rules were quite lengthy but was important. His ending was quite remarkable.
You check the slip in your hand.
“Ward 3” it says. You slowly walk toward your post.
“Dr. Kesh” You hear your nurse is shouting your name
DEFINITION OF TERMS
- Consent - The consent or receiving the willingness of the patient to undergo a medical procedure is a must before you would perform any medical procedure. It could be ranging from a simple needle prick test or to an imaging or an operation.
- IVF - Intra Venous Fluid. These are the liquid substances directly delivered into a vein.
.
Thursday, April 25, 2019
Tuesday, April 23, 2019
Think before you order a test: High resolution CT scan (HRCT)
Let's talk about HRCT today!
HRCT is the use of thin-section CT images (0.625-mm to 1.5-mm slice thickness) with a high spatial frequency reconstruction algorithm, to detect and characterize diseases that affect the pulmonary parenchyma and small airways.
HRCT cuts THIN slices.
Awesome, isn't it? Why not use an HD camera for every photograph?
Because it comes with a price!
Treating Alcohol withdrawal - scheduled vs PRN benzodiazepines
Sometimes it's frustrating to see different physicians use different approaches to management of the same condition or disease. How do you practice in that case?
You look at the evidence, the guidelines and make your own decision based on it.
Then even though if your attending practices something opposite of what the guidelines say, you know what is right and what you will practice in the future :)
Anyway, now that I am done venting - what do guidelines say about scheduled vs as needed benzodiazepines for alcohol withdrawal?
Wednesday, April 17, 2019
Chimeric antigen receptor T cells (CAR T cells) therapy simplified
I copy-pasted a quick short post in text for reference :)
Monday, April 15, 2019
Orthopaedics: Facebook Septic arthritis Vs Transient synovitis
#Medicowesome
#Orthopaedics
Q) A 4 year old kid comes to OPD with complaints of high grade fever, decreased appetite and pain in right hip. On examination he has dehydration/ tenderness in Scarpa's traingle/ swelling in right hip region, flexion, abduction and external rotation at hip/ absent movements in right hip region. On Xray there is mild increase in medial joint space. Diagnosis is
1) Septic arthritis
2) Transient synovitis
3) Tubercular arthritis
4) Dislocation of hip
Answer is 1) Septic arthritis
Let us dissect this Multiple choice question. Read the question one more time and let's follow up. Put your Sherlock holmes hat and let's see what we can deduce!
1) A 4 year old kid.
2) Toxic due to dehydration.
3) In his right hip we have - Flexion, abduction, and external rotation. This collectively is called as FABER! Big clue here.
4) Absent movements
Looking at the option given, we can definitely eliminate dislocation of hip. It has FADIR - Flexion, Adduction and internal rotation.
Coming to TB. Now if try to recollect the 5 stages of TB you will find that 1st stage is FABER and next two stages are FADIR! 5th stage is Fibrous ankylosia known as TB arthritis. 4th stage has Wandering Acetabulum (It is a misnomer because both acetabulum and femur head is destroyed so actually remaining part of femur wanders! - also known as - Pestle and Mortar type)
Now two options left - Transient synovitis and Septic arthritis. Well you know Septic arthritis is an emergency condition. Even if you don't know any thing about other option, you can still get it correct. Child is toxic and absent movements points out toward emergency condition.
Both Transient synovitis and septic arthritis causes FABER which leads to more space in the joint leading to more inflammation and swelling. Any swelling disease in Orthopedics is approached as
"XMAS"
X- Xray
M-MRI
A-Arthroscopy which is USG guided.
S-(for)Swelling diseases
Wait! What would be treatment modalitis for both of them?
Ofcourse surgery followed by 6 weeks of Antibiotics for Septic arthritis
Whereas Transient synovitis as name suggest is less severe so we do conservative treatment.
Remember:
Septic arthritis - Absent movements
Transient synovitis - Decrease movements