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PUT YOUR BEARD IN MY MOUTH
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Doug Jones
art blog(derogatory)
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Origami Around

blake kathryn

romaâ
"I'm Dorothy Gale from Kansas"
tumblr dot com
taylor price
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d e v o n
Sweet Seals For You, Always
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NASA
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YOU ARE THE REASON
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@fat4summer
Weekend goals. đ
I literally cannot express how much I love hugs. A good tight hug is in my top ten favorite things on this earth.Â
I am so in love with butter
Most bang-for-buck things every intern should know before starting inpatient wards
Source. A collection of Meddit resources and advice on what bread-and-butter topics interns would most benefit from brushing up on/memorizing prior to the beginning of their internship. 1) Fluids. How and when to use them, dosage, timing and other pearls.
Review of fluids (not how to use them per se) by Dr. Strong /u/ericstrong
Maintenance Intravenous Fluids in Acutely Ill Patients - NEJM.
Pretty thorough review of fluid management on openanesthesia.org
2) Nausea. When to treat, how to treat and at what dose.
3) Standard pn orders: pain killers, sleep aids and antiemetics aka how to reduce nighttime calls from nurses by 25%
4) âReflexâ antibiotic choice for routine inpatient infections.
http://www.bpac.org.nz/Supplement/2013/July/antibiotics-guide.aspx /u/ChristianM and /u/ive_been_up_allnight
5) Initial work-up and treatment of dyspnea. (more realistic to approach by symptoms as, unfortunately, you first have to diagnose whats wrong. E.g. heart failure, pulmonary edema, embolism, COPD, pneumonia).
6) Initial work-up and treatment of oliguria/anuria.
7) A sensible initial approach to suspected ileus.
8) Blood. When, how, why to replace.
9) Pain. Optimal management without inducing narcosis.
Managing cancer pain: Frequently asked questions: CCJM
10) Potassium. When, why and how to shift or replace.
A review on both potassium and sodium disorders by Dr. Strong /u/ericstrong (Not reposted in 12) hyponatremia but applies there as well) https://www.youtube.com/playlist?list=PLYojB5NEEakXVIAapcSEleP4doUdHVtld
11) Hyponatremia. Most common electrolyte disturbance, commonly mismanaged.
12) Resuscitation aka commit the ACLS algorithms to memory.
Current ACLS guidelines. https://www.acls.net/aclsalg.htm
Would love a video series, interactive cases etc.
13) Basic EKG interpretation.
Whole EKG video courses
A whole free youtube EKG video review course by medditâs own u/ericstrong
An alternative EKG course that takes you through all the basics. This however has no free version and costs 96$ a year. The quality is amazing. Here are 6 basic sample videos on youtube. The paid course is available on http://www.ecgteacher.com/
I have to admit I havenât used this course personally but his free youtube videos are on-point and he seems like a good teacher. Also behind paywall. Free youtube samples are here. The full course can be found here https://www.ecgacademy.com.
EKG video cases
Amazing case-of-the-week emergency medicine EKG videos on youtube by Dr. Amal Mattu
â If you like Dr. Mattuâs cases (and you most certainly will) he is still posting every single week on his new site https://ecgweekly.com. It costs 4 starbucks coffees a year and is going to save someones life.
Practice EKGs with answers
Watching videos isnât enough, you still have to grind out EKGs to keep your game strong. Visit http://ecgmadesimple.com and http://ecg.bidmc.harvard.edu/maven/mavenmain.asp for this.
EKG blogs
I recommend signing up for some kind of RSS feed (e.g. https://feedly.com/) and subscribing to the following EKG blogs:
http://hqmeded-ecg.blogspot.is (Dr. Smiths ECG blog)
http://www.ems12lead.com
http://ecg-interpretation.blogspot.is
http://jhcedecg.blogspot.is
EKG resource libraries
Life in the fastlane has a nice resource to look up a specific EKG finding, criteria or concept.
http://www.practicalclinicalskills.com/ekg.aspx /u/collidge
14) Know when to order ABGs and how to interpret them.
Almost too detailed video lecture series on ABGs and how to interpret them by Dr. Eric Strong (/u/ericstrong)
Practice makes perfect. ABG interpretation generator. https://abg.ninja/abg
Bonus 15) Basic CXR interpretation
CXR video lecture course
Again, Dr. Eric Strong has an excellent video course for free on youtube
Step-by-step guides to basic CXR interpretation
The Radiology Assistant: Chest X-ray - Basic interpretation
Radiology Masterclass step-by-step basic CXR
University of Virginiaâs step-by-step basic CXR
All inclusive resources
The art and science of thoracic imaging All inclusive resource for all things thoracic! Jokes aside amazing resource.
UPenns CXR learning website
Loyola Universities excellent CXR Atlas Most outdated look but amazing content.
Checklist approach to CXR
Bonus 16) Overnight o-shit-whatâs-that Head CT interpretation
Midnight radiology: Emergency CT of the head
University of Virginiaâs guide to the Head CT
Hey, self: review before NCLEX. Xo, me.
Oh hell yes
For future reference.
Must. Study.
Reblogging again to read ASAP.
Iâm pretty at this point in my life that my blood is 90% energy drink.
Treat yo self. âş
this beanie suits you wellâşď¸
Thank you. What about a navy one? Itâs such a lovely colour I want both.
why not, treat yo self!
Treat yo self. âş
this beanie suits you wellâşď¸
Just my two cents :)
February #GetKind: Nurses, Doctors & Healthcare Workers
This month, while youâre brainstorming ways to #GetKind, keep in mind the following tips and suggestions to help the healthcare workers in your community:
- Say thank you. - Arrive for your appointment on time. - Arrived a bit too early? Use the time to get to know the office administrators! - Feed them. - Take their advice seriously. - Have questions ready for your health care provider.
The act of kindness I always deeply appreciate is when someone doesnât go off on a huge rant if you are running late.
We know weâre running late. We know how long youâve been waiting; no matter what we are doing, the number of patients waiting is always at the back of our minds. Sometimes we look at a long list of patients and want to cry, because it seems like we will never get through everyone.
Itâs not our fault the patient before you was sick, or upset, or both. If you want a clinician with empathy who doesnât rush you out of the door, weâre going to run late sometimes.
Sometimes people bring up complex problems or loads of them. Sometimes itâs the very same people who complain about you running late who then want you to solve 10 problems at once.
I donât want to go home late any more than you want to be late. Itâs a horrible feeling when you realise that things are piling up.
GP appointments have gotten shorter, and the demand for appointments has increased. More people want more appointments, and there are less doctors to do it. A&Es everywhere are getting busier and busier as more of them close; more people come in to see less doctors. Weâre all working harder to make up for increased demand.
We donât choose to make you wait. Of course we expect you to vent your frustration. Thatâs understandable. But you have no idea how demoralising it is to be ranted at about things running late, when that time could be used to deal with the medical problems. Rant for too long and youâll run even later, and weâll run later for tge next patient. The majority of patients are understanding, and they have our gratitude more than they could ever know.
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Here is a case I will never forget. A 45 year old man with reported no prior medical history comes in to the ER screaming of excruciating acute onset substernal chest pains 20 minutes prior to arrival. He says he was fine prior the onset of the chest pain, then suddenly became short of breath and has an âelephant on my chestâ with pain down the left arm. He is afebrile with a heart rate of 65, respirations 20, blood pressure 142/72 with normal oxygen saturations. Sublingual nitroglycerin was given 3 times without relief so IV morphine was given and his chest pain eventually subsided. Here is his ECG:
STOP!!!
Lets think about this hereâŚhis clinical picture sounds typical for acute MI, right? A little too typical. The ECG shows a little anterior ST elevation. But look closely at the ECGâŚnotice something?
The cath lab is activated for an anterior ST elevation MI. A coronary angiogram showed that his right coronary and circumflex coronary arteries were normal. His left anterior descending (LAD) wasâŚchronically totally occluded consistent with an old remote MI.
OK then. No acute LAD thrombus here like the clinical picture might make us think. Notice those Q waves in the anteroseptal leads V1-V3? That is NOT consistent with acute chest pain for 20 minutes! More like an old anterior MI.
Lets talk about Q waves
The Q wave is the first downward deflection of the QRS complex that occurs before the R wave. It is normal to have small Q waves in most leads. We consider a Q wave pathologic (abnormal) when:
More than 40 ms (1 mm) wide
More than 2 mm deep
More than 25% of the total QRS complex amplitude
Present in leads V1-V3
What does âpathologicalâ mean? This means a certain disease process is present, specifically myocardial infarction, usually old. These Q waves take some time to develop and would NOT be present within 20 minutes of symptom onset. They take at least a few hours to a couple days after an MI to develop and can persisist for lifetime in many cases, especially if coronary revascularization is not performed quickly enough. Here is a comparison of normal Q waves in the inferior leads compared to pathologic Q waves:
Lets review the ECG in an acute MI briefly
Hyperacute T wave changes are the first ECG change during acute MI and are quite transient, so usually missed. Here is an example of hyperacute T waves:
The second change is ST segment elevation at the J point. Here is a picture of an acute anterior ST elevation MI with 5 mm of ST elevation at the J point. They call this âTombstoningâ since the combination of the ST segment and the T wave look like a tombstone:
Eventually the ST elevation resolves and if the infarct completes, a âpathologicâ Q wave develops like in our patientâs ECG. An old anterior MI would have pathologic Q waves in the anterior precordial leads (V1-V3) and an old inferior MI in the inferior leads (II, III and aVF).Â
Frequently we revascularize acute ST elevation MIs quite quickly and Q waves donât develop. The term âQ wave MIâ is an old term that used to refer to âtransmuralâ infarctions resulting in Q waves in the ECG.
Here Comes the Twist in the Case
He remained chest pain free and his cardiac enzymes remained normal throughout the hospitalization. A couple hours after the angiogram I was called to check on him due to left groin pain. There was good hematoma there. OddâŚI was pretty sure right femoral artery access (not left) was usedâŚso why a left groin hematoma?
A little investigating was done and we found out he DID have a prior history. Actually, this was about coronary angiogram twenty (yesâŚ20) in the past 6 months! Almost every hospital in the area had records of him coming in with chest pains, not relieved with nitroglycerin and then relieved with IV morphine!
We confronted the guy. He admitted that he knew his ECG was abnormal and mimicked an anterior STEMI and he was addicted to IV narcotics! Crazy. But he got the story wrongâŚhe should have said chest pain for 1-2 days in order to truly fit his ECG pattern, not acute onset of chest pain for 20 minutes!
We found out that his initial anterior MI was 6 months ago. Wait! How is there ST segment elevation on his ECG then? WellâŚthats because his LV angiogram during the cath showed that he had a left ventricular aneurysm!
Here some of the classic findings of left ventricular aneurysm:
Chronic ST segment elevation
Pathologic Q waves
Shape of the ST elevation seen in a LV aneurysm described as âcovingâ.
Here it is again:
Here is what a left ventricular aneurysm looks like. See how the apex is thinned and buldges?
Two side notes
First, there is really no clinical evidence to support this classic teaching of persistent ST elevation after MI being from left ventricular aneurysm. Some studies show that persistent ST elevation correlates more with âdyskineticâ wall motion (myocardium moving outward instead of in during systole) and not necesarrily just with aneurysmal changes.
Second side note. According to the ACC/AHA guidelines for STEMI, to diagnose an anterior ST elevation MI there must be âNew ST elevation at the J point in at least 2 contiguous leads of ⼠2 mm (0.2 mV) in men or 1.5 mm (0.15 mV) in women in leads V2âV3 and/or of âĽ1 mm (0.1 mV) in other contiguous chest leads or the limb leads.â Thus, 1 mm in any 2 contiguous leads EXCEPT leads V2 or V3 where the elevation must be 2 mm in men or 1.5 mm in women. This guyâs ECG was borderline for meeting those criteria.
The ECG Dilemma
How could we have figured this out? The ECG has some good Q waves in V1-V3 which is consistent with an OLD anteroseptal MI. His symptoms were quite acute, but he knew all the key words to say. Really, the only way to know for sure the ST elevation on his ECG represents an left ventricular aneurysm is to have clinical history of a prior anterior MI and cardiac imaging showing the aneurysm. So when a guy like him says he has no prior history and has severe chest pains with an ECG like hisâŚthe cath lab gets activatedâŚ
How about a nice universal electronic medical record (EMR) to prevent this problem?
This patient was âmalingeringââŚattempting to fake his illness for some secondary gain, in his case for IV narcotics. Here is a nice article on malingering and why it is important.
Iâll never forget another case I saw during training of fever of unknown origin that was presented in our grand rounds. A guy with recurrent bacteremia of multiple different microorganisms. He had every MRI and CT scan possible as well as a lumbar puncture and transesophageal echocardiogram to exclude endocarditis. Multiple infectious disease specialists were consulted and nobody could figure him out! We found out that he was actually malingering by injecting feces into his IV! Oh myâŚ
Visit this article on LearnTheHeart.com and post a comment
View the LearnTheHeart.com Cardiology and ECG Blog here
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Related Links:
Topic Review: ST Elevation MI
Topic Review: Left Ventricular Aneurysm
References:
1. Chouâs Electrocardiography in Clinical Practice: Adult and Pediatric, 6e
Image Reference:Â CC Patrick J. Lynch and C. Carl Jaffe, Yale University, 2006
By Steven Lome
I wonât pretend to be an expert on anxiety, but I have experienced feelings of anxiety of the social kind as well as general anxiety towards various aspects of my life. I spent over a year and a half in what I can only describe as a depressive state which, combined with these crippling feelings of anxiety, affected my ability to focus on school work. My motivation to make this post was triggered by several messages Iâve received in the few months that Iâve been a studyblr, asking me how one can balance studying and anxiety. I have attempted to compile a list of resources that will help anybody out there who suffers from anxiety, no matter how severe. Some of these resources are external sources and some are just personal views/pieces of advice based on things that really helped me. Some will relate specifically to studying whilst some will relate generally to taking care of oneself. They wonât work for everyone, but I hope these help at least one person feel better.
Apps
Pacifica From simply telling the app how you feel to conducting deep breathing exercises, this app aims to flush away as much of your anxiety as possible by combining elements of mental and physical relaxation. Logging your feelings like this can help you track patterns and triggers in your anxiety, which can help you prepare or control for those triggers in future. Nobodyâs anxiety is the same, so this helps you understand your own anxiety as opposed to the general umbrella-term definition of anxiety they give online. This technique might not be equally effective for anyone, again partly because of how diverse anxiety is, but part of understanding your own anxiety is also understanding what doesnât work. So trial it for a week or so, and if it doesnât work you absolutely donât have to continue using the app.
Self-help for Anxiety Management (SAM)Â Similar to Pacifica, SAM was developed by a team of Psychologists, Computer Scientists and students at the University of West England. This app has great reviews and not only has it been trialled by the student demographic but it was developed in part by them too. This app also enables you to build your own bespoke toolkit of in-app resources based on what you find personally helpful.
Other resources
My self care tag features a lot of posts (by other people) that have resources to help you look after yourself. Most of these are nothing to do with studying or academia; Instead, they focus on general wellness and self care
How to deal with anxiety when learning by David Mansaray
Printable anxiety self-help guide by Moodjuice
Anxiety and panic attacks by Mind
Managing anxiety with creativity by Mind
10 best ever anxiety management techniques by the Australian National University
How Do You Feel? By This Way Up This page helps you establish exactly what emotions it is that youâre feeling and gives you self-help advice based on that specific feeling/those specific feelings. They even offer courses to help you control and hopefully overcome your anxiety. They report that 80% of users benefit substantially from using their programmes, whilst 50% emerge reporting that they are no longer affected by anxiety. A 3-month supervised course costs $59 AUD. Online courses/iOS courses are also offered, but those are only available in Australia. If youâd require a parent or guardian to pay on your behalf, please ask the cardholderâs permission before you purchase the course. Courses are viewable here but you can navigate the site to find courses that fit different, specific needs.
20 scientifically backed ways to de-stress right now
Personal advice
These are things that have worked for me personally, so Iâm sharing them with you in the hope that they help some of you too.
Break things down. Looking at the big picture can be daunting and triggering. This works for general tasks as well as for academic ones. Break down your day into a list of all the individual things you need to do. First of all, externalising the information and making it a visual list as opposed to a jumble of thoughts will help you make sense of everything. Then, look at the tasks you have and see if they can be broken down further. For example, if you have a 30-page chapter in a textbook you need to read, break that down into 6 sets of 5 pages as opposed to one big lump of 30 pages. Then, take it five pages at a time. Each fifth page that you read is a stepping stone achievement towards the main achievement and having those smaller, more readily achievable goals to aim for really will help. This also works with academic topics in general. If you have a really complex concept you need to digest and remember that you just canât make any sense of, break it down into the simplest terms possible. For example, start with âIn the English language, there are consonants and vowels.â Once youâre certain with that, try and further that to âThere are front, central and back vowels.â And âThere are nasal, plosive, fricative, etc. consonants.â Get comfortable with each extra step you take before you take another step towards the more complex stuff. Learn things and break them down until you could teach them to someone else.
Widen your margin of error. This one was the most difficult for me to achieve, but if you work towards it, you will get there. Itâs all about accepting that perfection is unattainable. Nobody is perfect. Everyone messes up, everyone makes mistakes, and everyone makes wrong decisions. Itâs a part of life and itâs a part of how we learn. Whether itâs tripping over your words whilst talking to someone or failing a test, you need to allow yourself to accept that itâs happened and you canât change it. Focus on what you can change (i.e. your future) as opposed to what you canât change (i.e. the past). Sure, you could have gotten a B on that test if youâd studied more. But you didnât. And you canât change that now. So why worry about it? Worry about making sure you do get a B on the next test by studying further in advance. It took me so long to learn to think like this but now Iâm able to put things into perspective. If Iâm worrying about something I ask myself âWhy am I worrying about this?â and then âCan I change this?â. I often find that the things Iâm worrying about are either things that have already happened and I no longer have control over, or things that are yet to happen that I am totally capable of controlling for.
Try to avoid catastrophizing. Itâs all so easy to think âIâll never get this done today.â When youâre working on a really long, difficult piece of work. Â Sometimes, you get so caught up in thinking that youâll ânever get this doneâ that you waste precious time worrying about it when you could be making progress. Instead of saying âIâll never get this done.â, try thinking âOkay, maybe I donât have as much time as Iâd like to complete this. But Iâll make the most of the time that I do have and do as much as I can.â
Trick yourself with early deadlines. This one was a game changer for me after dragging myself (and what felt like 1000 tonnes of anxiety through my third year at Uni). This year, when Iâm told a deadline by a lecturer, I write it down in my planner two days before that date. So if a deadline for an assignment is 11:59pm on Friday the 15th of January, I write it down in my planner that the deadline is 11:59pm on Wednesday the 13th of January. Then I work towards that deadline as though thatâs the actual due date. This means that even if I donât start the assignment until âthe day before itâs dueâ (the 12th), I still then have a couple of days to fix it up before the actual deadline. This wonât work for everyone, but itâs changed my life.
Change where youâre studying. Sometimes, you develop negative connotations with a certain room or space. Sometimes itâs good to associate a certain activity with a certain space, but a lot of people study in their bedrooms which is also the place they tend to go when theyâre feeling anxious/depressed. So try switching it up. Study in the kitchen, or the lounge, or the library, or outside someplace, or at a coffee shop. Somewhere different that extracts you from the environment you associate with negativity and into a new, positive-feeling environment.
Talk yourself out of it. Quash negative thoughts as soon as they sprout. All it takes is a spark to start a fire, so you need to stamp that spark out before it can do any damage. This relates back to catastrophizing, where you feel like youâll never get something done and then your mind takes you down this long, winding path of catastrophe after catastrophe and before you know it youâve given up entirely on studying because whatâs the point? If you counteract these negative thoughts with something more productive like âI might be starting a couple of paces further back than Iâd like to be, but at least Iâm starting.â
Hold a pen between your teeth. I know this seems ridiculous, but this is something that absolutely works for me. You know how people tell you to smile even when youâre not happy because it tricks your brain into thinking youâre happy? Well bullshit to that. Sometimes you just donât feel like smiling right? Sometimes, even, you canât smile because you feel so down. Instead, pop a pen between your teeth and hold it there, with your teeth bared. This has the same effect on your brain, only youâre not having to force yourself to smile. Besides, it might even cheer you up because youâre sitting there now biting down on a pen because some stranger on the internet told you to. But it genuinely works. You might not feel happy and dandy just because you held a pen in your mouth, but your mind will react in ways that you donât necessarily pick up on.
Keep a diary. Donât make it so that you have to write a page-long entry about your feelings every day because this can be as triggering as anything else. Instead, keep a little pocket book somewhere that you can access easily if you need to. Split the pages into three columns: How I feel; What caused it; and Action. In the how I feel column, write the emotion youâre experiencing. In the next column, write what triggered that emotion, whether itâs school work or a friend or a family member or a social situation. Next, write down what youâre doing to turn that emotion into something positive or something you can learn from. I used this technique last year, and itâs basically a way of logging your feelings in the same way as you do with the apps Pacifica and SAM. It helps you visualise your triggers but you have the added, positive element of seeing the action youâre taking to try and elevate your anxiety. Externalising your thoughts by writing everything down makes them seem more manageable.
Exercise. Exercise really helped me overcome my anxiety. Even if it was just 10 minutes, there was something so invigorating about it that I just wanted to keep going, mentally and physically. After I was done working out and Iâd showered and felt good, Iâd want to keep that feeling going by doing more productive things. Plus, working out helped relieve stress through physical exertion. Exercising always boosts my focus, motivates me, and releases stress, plus you can get fitter at the same time.
See a counsellor/doctor. Some people arenât comfortable visiting a doctor because they think theyâll immediately be put on medication. This is when it might be advisable for you to visit a counsellor. Most universities offer a counselling department where trained professionals listen to your problems and provide advice where they can. They can recommend that you visit a doctor if they believe that you need medical assistance. If your anxiety is really bad, though, I wouldnât rule out the option of going to your doctor.
I hope this helps you in some way. Iâll say it again: Iâm not medically qualified to give professional advice. I am merely sharing whatâs worked for me in the hopes that it helps somebody else out there who is suffering. These things wonât work for everyone because everyone works in different ways and everyoneâs anxiety is different, so please donât fall under the impression that I think everything Iâm saying here is gospel. Thank you for reading, and good luck to all of you!
Thank you for this
Youâre welcome!
They can teach you anything.
Forget overpriced schools, long days in a crowded classroom, and pitifully poor results.
These websites and apps cover myriads of science, art, and technology topics.
They will teach you practically anything, from making hummus to building apps in node.js, most of them for free.
There is absolutely no excuse for you not to master a new skill, expand your knowledge, or eventually boost your career.
You can learn interactively at your own pace and in the comfort of your own home. Itâs hard to imagine how much easier it can possibly be.
Honestly, what are you waiting for?
Take an online course
edXâââTake online courses from the worldâs best universities.
CourseraâââTake the worldâs best courses, online, for free.
CoursmosâââTake a micro-course anytime you want, on any device.
HighbrowâââGet bite-sized daily courses to your inbox.
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Learn to work with data
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Learn new languages
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BusuuâââThe free language learning community.
MemriseâââUse flashcards to learn vocabulary.
Expand your knowledge
TED-EdâââFind carefully curated educational videos
Khan AcademyâââAccess an extensive library of interactive content.
Guides.coâââSearch the largest collection of online guides.
SquareknotâââBrowse beautiful, step-by-step guides.
LearnistâââLearn from expertly curated web, print and video content.
PrismaticâââLearn interesting things based on social recommendation.
Bonus
ChesscademyâââLearn how to play chess for free.
PianuâââA new way to learn piano online, interactively.
Yousicianâ Your personal guitar tutor for the digital age.
List of Medical Documentaries
History of Medicine Ancient Egypt: Medicine and History (History Channel, âWhere Did it Come From?) Forbidden Knowledge: Ancient Medical Secrets (Discovery) Getting Better: 200 Years of Medicine (New England Journal of Medicine) Human Anatomy and Medicine (Discovery) Lost Tomb of Imhotep (Ancient Egypt Documentary)
Antibiotics/Antivirals Frontline: The Trouble with Antibiotics (PBS) Rise of the Superbugs (Dailymotion) Origin of AIDS: The Polio Vaccine (CBC: Witness)
Business of Medicine The Business of Being Born (Barranca Productions)
Disease/Infection Siddhartha Mukherjee - The Emperor of All Maladies: A Biography of Cancer, Lecture (Harvard Book Store) Pain, Pus and Poison - Pus, The Search for Modern Medicine (BBC; @medicine-nerd)
Global Medical Missions MÊdicins sans Frontières: From Action to Words (MSF) Living in Emergency: Stories of Doctors without Borders (MSF Australia)
Health Care Escape Fire: The Fight to Rescue American Healthcare (Lionsgate;Â @stayingmedicallyinspired)
Human Behavior Pleasure and Pain Documentary with Michael Mosley (BBC)
Pioneering Physicians Present and Unaccounted for: Black Women in Medicine (URU, The Right to Be, Inc.)
Pharmacology Pain, Pus and Poison - Pain, The Search for Modern Medicine (BBC; @medicine-nerd)
Medical Dramas Boston Med, Season 1 (ABC) Emergency Room: Life + Death at Vancouver General Hospital (Knowledge Network) Hopkins (ABC) NY Med, Season 1 (ABC) NY Med, Season 2 Episode 1, 2, 3, 4, 5, 6, 7, and 8 (ABC)
Medical Education Doctorsâ Diaries:Â Part 1 and Part 2 (PBS NOVA) âI am a Medical Studentâ - The Motivations and Interests of 5 Future Physicians (Mauch Scott)
Research Science Documentary: Stem Cells (UCL)
Surgery & Surgical Procedures Surgeryâs Dirty Secrets (BBC) The Lobotomist, Walter J. Freeman: Part 1 and Part 2 (PBS) Extracting a Deadly Brain Tumor (University of Miami School of Medicine; @medicine-nerd) The Human Face (BBC)
Toxicology Pain, Pus and Poison - Poison, The Search for Modern Medicine (BBC) The Venom Cure (PBS; @medicine-nerd)
War & Medicine Nuremberg: Nazis on Trial (Parts 1-3) (BBC) Battlefield Medicine (History Channel) Modern Marvels: Battlefield Medicine (History Channel) Surgeons at War: Combat Surgery in World War IIÂ (Unknown) Frontline Medicine (BBC)
Please note: This list is updated regularly. If you have any documentary suggestions, please share!
Most animals have smooth brains. The brains of humans (and a handful of animals we consider pretty intelligent â dolphins, chimps, elephants, pigs) start out smooth in the early days of gestation and get more and more wrinkled through infancy.
A wrinkled brain makes sense - folding means you can have a really big cortex but the different parts of the brain wonât be as far apart. But how do brains become wrinkled? Is it programmed somehow - does some genetic code determine the pattern of folds?
A new study from Harvard says no - its just simple physics. They created a 3D model of a smooth fetal brain and coated it with an elastomer gel âcortex.â When they immersed this brain in a special solution, the gel swelled, mimicking brain growth.
Lo and behold, the brain began to buckle, creating folds similar to size, shape and location of a real brain.
Image credit:Â Mahadevan Lab/Harvard SEAS
Fake brains are cool brains.
Basics for the Wards: How to Read EKGs
Iâm on cardiology right now, and yesterday the fellow taught us some basics for interpreting EKGs. The trick is the have a thorough algorithm and do it every time so you donât miss anything.
Disclaimer: Obviously this is just a cursory intro so folks wonât look like complete fools like me- who, when asked to interpret an EKG, went into a cold sweat and said, âWell, it looks like the heart is beating.â Attendings do NOT like that.
INTRO
This is what a normal lead II EKG one beat reading should look like. TAKE NOTE LITERALLY EVERYONE STOP CALLING YOUR SQUIGGLY LINES HEARTBEATS IT IS WRONG GAAAHHHH.
Normal EKG.
What the various leads are monitoring.
1. Rhythm: Sinus or not- aka, is the SA node talking to the AV node correctly? Check in leads V1 and II- if there is a P wave before every QRS you have sinus rhythm. If this is not the case, you do not have sinus rhythm! A whole discussion on things messing up sinus rhythm will come when I have a better grip on it myself.
2. Rate: How fast is the heart beating- aka, how fast are the ventricles depolarizing? So EKGs are little tiny boxes in bigger boxes, right? There are several methods for calculating rate using the boxes, but the one that works for my brain is to count the big boxes between Râs and divide that by 300. So, 1 big box between R = 300/1 = 300 bpm. 2 big boxes between R= 300/2= 150 bpm. And so on.
In general, any heart rate above 100 is tachycardia, and any heart rate below 60 is bradycardia. These values may vary (ex: SIRS criteria counts heart rate above 90 as tachy). Normal heart rate is around 75 (exceptions include athletes- look up athletic heart syndrome)
3. QRS Complex: Wide or narrow- aka, is the Bundle of His bossing the ventricles around? Basically, a nice narrow QRS complex generally indicates the bundle of His is intact and operating how it is supposed to. A wide QRS complex indicates something is awry with the Bundle of His- could be an organic pathology, could be a medication side effect (ex: antiarrythmics, TCAs, quinidine, to name a few), could be an electrolyte imbalance (ex: hyperkalemia), could be other things.
4. Axis: Is the heart depolarizing the way it should- aka right shoulder to left nipple. I, personally, am still sorting out the axis system, and itâs hard to do in this format. The first, most basic place to start is checking if lead I and aVF are POSITIVE, meaning their QRS complexes go ABOVE the isoelectric line. If that is the case, you are probably ok axis-wise.
Essentially, lead Iâs vector goes from left to right, and aVFâs vector goes from head to toe. So the average of those vectors is the general path of depolarization of the heart. You want the axis to be between -30 and +90. So, if aVF is positive, but lead I is negative (the QRS is below the isoelectric line) that means it is going from left to right instead and would be classified as a right shift. Likewise, if lead I is positive, but aVF is negative, that means it is going down to up and would be classified as a left shift. There is soooo much more to axis interpretation, this is just a starting point.
5. Intervals: Again with the conduction system, itâs, like, totally important that it obeys all the rules every time. PR= <.2 seconds, or one big box QRS= <.12 seconds, or 3 small boxes QT= < ½ the RR interval
6. ST segment changes: checking for CAD- aka, is the myocardium getting enough blood/oxygen? Since the folks in the South seem to consider butter a food group and know that if it canât be fried itâs not worth eating, CAD is a huuuuuuuuge issue here. When blood supply to the myocardium is compromised, there will usually be characteristic EKG changes. Note- not every episode of angina/MI will have EKG changes though! - Inferior leads â> right coronary artery. - lateral leads â> circumflex artery - anteroseptal leads â> left anterior descending. Disclaimer: does not apply to everyone all the time, some folks have variant coronary anatomy.
So the EKG changes to look for must be seen in two contiguous leads, aka, two inferior leads or two lateral leads. - Ischemia (low oxygen) = ST depression or T wave inversion (EXCEPT T wave inversions are ok in leads V1 and aVR)
- Injury = ST elevation
- Old infarct/dead myocardium = pathologic Q waves. Basically that first negative vector (aka, the Q of the QRS complex) should never be bigger than one tiny box.
And, that, friends, is a basic algorithm for reading EKGs! There is a lot more, but if you follow these steps every time, you will look like a rock star on wards. Good luck!
How in hell do you get âDickâ from âRichardâ?
you ask him nicely
I needed ibuprofen after this.
âWhoâs your best friend?â
@alittledude
Awww