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@foreverlearning-foreverstudying
Remember what you are working towards. Don’t let your emotions throw you off when things aren’t going according to plan. Discipline and remember how you need to think and act in order to achieve what you need. You don’t have to fake your positivity but you also don’t have to act like your world is ending when things are turning out differently. Learn to discipline yourself in tough moments and to go with the flow of what’s being presented to you. Master yourself.
I’m so nervous about this exam and presentation
Everything feels so overwhelming. How did I not know we had an exam?
Even though this psych rotation was boring, I was able to finish my project and submit my application without added stress of cramming for this exam
Does anyone else feel like a nuisance when asking someone for a letter of recc? Especially if I haven't spoke or seen from this person in so long..
I think my time in PA school would've been much better if my apt wasn't so terrible. I'm sitting in the coffee shop I used to frequent when I first started and already feel the nostalgia
I should be refreshed and ready to finish off the next 3 months with the a bang after my month long break, but I've been so lazy. I've had a four day weekend and barely managed to study/complete projects. All I want to do is binge TV shows, sleep and play games on my phone. I can't find any motivation
If you're sitting on your phone watching titoks/fb videos... I don't need to be here and pls let me go home
Kind of annoyed that I went through all the trouble of getting physical copy of this recc letter and it needs to be emailed from the person who wrote it...
On a recent shift, I had the cutest, chubbiest little 8 month old bean get transferred to our tertiary children’s hospital from the community. She had a full head of hair and was absolutely the squishiest of little beans.
The reason she was transferred in was concern for a possible stroke, as she just suddenly stopped using her right arm since bath time the previous night. There was no known trauma, no fall, no swelling or bruising or deformity to the arm… the referring hospital had done radiographs of the limb that were normal and even did a cranial ultrasound to rule out a big bleed, but there was nothing to be found. They astutely attempted to reduce a pulled elbow given the normal radiographs, but to no avail. Hence, they sent them to us with our neurology team on deck to assess for a stroke.
My fellow went in to do an initial assessment and came to grab me because she was concerned that this kid was indeed not moving her right arm. Given the need for expedient intervention in case of a stroke, I booked it into the room.
As part of my exam, I noticed the kiddo was moving her right wrist and fingers just fine, but seemed hesitant to move at her elbow. I could coax her into moving her shoulder on that side. She had no other neurologic deficits, and responded appropriately to touch to her whole right upper extremity… wasn’t clinically in keeping with a stroke. I tried palpating the elbow itself, and other than lots of anxiety she didn’t seem to be actually tender anywhere…
Now, my fellow had also tried to see if this was a pulled elbow and used both the hyperpronation and the supination + flexion techniques for reduction with no success. I thought, “well, it wouldn’t hurt” and repeated these techniques. Lo and behold, I got a nice solid little “click” at the radial head and little bean was mad. SO MAD, in fact, that she started flailing her RIGHT ARM and trying to bat me away.
Everybody in the room was flabbergasted. Her parents looked at me like I was a wizard.
“She’s moving it! It’s normal again!”
I gave them a little thumbs-up sign and told them, “We will check back in a few minutes after she’s calmed down just to make sure her whole arm is moving well, and if it is, you’re good to go home.”
One of the triage nurses later messaged me through our secure EMR chat saying, “Did you just cure the stroke?”
My fellow was a bit flustered as we came out of the room. Understandably, she felt like she had done the reduction techniques without success, and that they had been done multiple times previously, therefore the suspicion of stroke was so much higher on the differential.
It was actually a great opportunity to teach a few things:
Bias: there were a few at play here, in that we almost assumed this was a stroke because the reason for referral was stroke, and therefore we may or may not have prematurely closed our Dx on this. However, the clinical picture still didn’t fit, so I felt like it was worthwhile to check for the pulled elbow myself.
Reducing pulled elbows: I gave my fellow a few tips and tricks, because clearly she had used the right techniques but may not have optimized them, especially for a loosey-goosey little infant that is much more flexible than even our toddlers that often get this annular ligament subluxation. A few things that can increase your success: first, apply the supinating or pronating force to the distal radius, NOT the hand, as the wrist can actually absorb quite a bit of the rotational force and therefore diminish your effectiveness; next, you may be surprised how much rotational force you can actually apply to a little bean’s arm because they are so loosey-goosey, and it will not hurt them (often doctors that work mostly with adults are afraid to do this!); finally, stabilizing the humerus is important to again not lose your rotational force! We often remember to palpate at the radial head to feel for the click, but usually forget to stabilize the humerus. If you hold the affected elbow with your contralateral side (e.g. hold the right elbow in your left hand) from underneath like you are cupping the olecranon, you can wrap your thumb around the lateral condyle and still keep your second or third fingertip on the radial head to palpate AND stabilize the humerus at the same time.
On reassessment, little bean was super smiley and happy and moving both arms to wave around her bottle and her toys and her book. Parents were very relieved. Neurology at our hospital was a bit confused but nonetheless grateful to not have to rush an otherwise healthy kiddo into the MRI. My fellow felt more confident about approaching their next pulled elbow. Little bean didn’t really express anything other than drooly, goobery giggles but I was pretty happy with that outcome ;)
SIDE NOTE: great way to check cranial nerves 7 in babies = squish their little cheeks and look for symmetric facial expression after, and for cranial nerve 5, see if they try to nom on your fingers.
After waiting all day to have an epiphany or moment of clarity/understanding about how to analyze the data I collected from these articles... I've settled on 3rd grade descriptive statistics and making some very inaccurate generalizations about them. I'm not a statistician so I refuse to put forth any more effort and thought. My discussion is going to be how this "study" is a sham and more research needs to be done 🤷🏾♀️. Its' not a meta analysis at this point, but idgaf anymore. I have no plans on doing research after I graduate and i'm certain no one is going to care that much when I present. If they do... they answer is "I'm not sure". My graphics are going to be some cute tables and dassit.
I truly have no interest in conducting research. I dread having to do this project. I have no clue what I'm doing and I have no clue why it is required for my degree
How do you manage "resistant hypertension"? Try nephrologist Dr. Blaise Abramovitz's SMASHMOUTH mnemonic:
S-pironolactone--the best 4th medication (after a diuretic, an ACEi/ARB, and a CCB) M-edication regimen--ideally 1 diuretic (chlorthalidone) + 2 other meds A-dherence--it's not resistant hypertension if the patient is non-compliant S-econdary etiologies--the younger the patient, the more you should think about this H-ome BP measurements--needed to diagnose both masked hypertension and white-coat hypertension M-edications that increase BP--NSAIDs, OCPs, stimulants, calcineurin inhibitors, etc. O-SA--untreated sleep apnea can increase BP 12/8mmHg during the day and 15/12mmHg at night U-nderdosing--it's typically better to maximize the dose of one medication before adding another one T-able salt--aim for a dietary sodium intake of <2gm/day H-erbal supplements--things like licorice and St. John's Wort can also increased BP#TeachingRounds, #FOAMed, #HTN, #nephrology, #pharmacology, #cardiology, #primarycare
Still pissed I didn't get an A all because of a quiz grade
