Infectiously Studious, MD-to-be

lilly • intp • ravenclaw microbiologist • epidemiologist • future pediatrician (MS1)

[umbillicus]

[nothingbutnetters]

Sum up pediatrics in one picture:

[renaissance-art-blog]

Anatomy of the Neck, 1515, Leonardo Da Vinci

[licensetomurse-deactivated20200]

EdFLUcation: Educating your patients (and yourself) about “the flu”

Whilst sitting at home with newly diagnosed influenza A and beginning my Tamiflu, prednisone, and jacked up cough syrup regimen, I thought, “what a perfect opportunity to share a some tips on patient education with regards to the flu!”

A patient comes into the ED c/o body aches, chills, fever, cough, etc., and you shove gently ease the flu swab down their nose and tickle their brain. You send it to the lab and 15 to 30 minutes later you get a call from the lab with a critical value: influenza type A. So you tell your patient, “Sorry, you have the flu.” Then your patient throws you a curve and asks, “Which one?”

After reading this post, you’ll be ready to dazzle them with your medical knowledge. Are you ready to learn some shit? Hell yeah, you are! Let’s do this!

There are four types of influenza viruses: A, B, C, and D. Human influenza A and B are the seasonal viruses that cause epidemics each winter. Influenza C is a milder virus typically causing respiratory illness, but not on the epidemic scale. Lastly, there is influenza D, which is primarily found in cattle, so, yeah, we can skip that one.

Influenza A is further divided into two subtypes corresponding to a pair of proteins on the surface of the virus; H (hemagglutinin) and N (neuraminidase). Starting to sound familiar? H1N1?

There are 18 subtypes of hemagglutinin and 11 subtypes of neuraminidase. According to the CDC, there are currently two strains of influenza A found in humans: H1N1 and H3N2.

Influenza B is not broken down into subtypes. Instead, it is categorized by lineage and strain. The CDC reports there are currently two flu B lineages: B/Yamagata and B/Victoria.

Which is worse, flu A or flu B? Your patient is sure to ask you this question at some point. The conventional wisdom is that flu B has always been milder because it’s slower to mutate than flu A. But, new research suggests that there is no difference in severity between flu A and flu B in hospitalized adult patients.

How do you treat the flu? Zanamivir (Relenza) and oseltamivir (Tamiflu) are antivirals that work against flu A or B. They essentially shorten the duration of flu symptoms by a day, maybe two. Typically, you must begin these drugs within the first 48 hours of onset of symptoms.

For flu B, there are rimantadine (Flumadine) and amantadine (Symmetrel). Rimantadine, like the flu A meds, is most effective if given during the first 48 hours. I couldn’t find information about timing for amantadine, though.

And, of course, lots of rest and fluids.

Lastly, patients will often ask how long does it take to get sick and how long are they contagious?

Typical incubation time for the flu is 1 to 4 days. Adults may be contagious 1 day prior to showing symptoms and 5 to 7 days after symptoms appear. Younger people, and those with weakened immune systems may be contagious for longer.

There you have it. Your edFLUcation from your flu A positive ER nurse. If you found this useful, please share it, with attribution, of course!

Sources:

https://www.cdc.gov/flu/about/viruses/types.htm

https://www.cdc.gov/flu/professionals/acip/clinical.htm

https://www.cdc.gov/flu/news/flu-study-viruses.htm

https://www.livestrong.com/article/22081-signs-symptoms-type-influenza/

[starsberrisnunicorns]

“A Thread of Tips” by Shelby

• #16 is missing but to find out more tips, follow her on twitter; be sure to thank her! 😁

disclaimer: check sites and tips before using at your own discretion.

[infectiouslystudiousmd]

Uhhh??? The vagus nerve doesn’t connect to your thumb???

[dr-dre-anatomy]

THAT FIRST SMELL OF ANATOMY LAB

[dr-dre-anatomy]

Throwback Thursday

[walkingwizardtribute]

[medlabscience]

Escherichia coli

[medicalschool]

[medlabscience]

The pancreas and its associated vasculature 

[tobeagenius]

How Does Alcohol Make You Drunk?

As you know, I started university this year and since then I have made some embarrassing descisions as a result of alcohol consumption. Making this educational infographic about the science behind drunkeness balances it all out right..?

[wayfaringmd]

Three Snaps

*our hero, Wayfaring, enters the exam room to see a teenaged boy with a rash*

Wayfaring: *is nearly knocked over by Axe body spray stank*

Patient: I got this itchy rash on my chest that has been here forever.

Wayfaring: Let’s see it.

Patient: *lifts shirt to show rash in a Z shape distribution on his torso*

Wayfaring: yeah that’s contact dermatitis. I’m gonna give you a cream for it but to keep it from coming back I would recommend avoiding scented soaps, lotions, and detergents. Oh, and cologne.

Patient: You think this is from my cologne?

Wayfaring: lift your shirt up and look at it. What motion do you do when you spray that body spray?

Patient: 

Patient: ohhhhhhhhhhhhhhhh

[wayfaringmd]

Talking and Words and Stuff

Work partner: *catches me in the hall* Ooh! Hey, you’re good with words. I have a question.

Wayfaring: Shoot.

Partner: *whispers* What’s the science word for butt crack?

[straightwhiteboystexting]

Calling American + Canadian English Speakers and Québécois French Speakers!

Hello/Bonjour ! *version française suit*

If you are a native English speaker from Canada or a native English speaker from the United States, please consider taking 10-15 minutes of your day to complete this survey about patterns in Canadian and American English. It’s part of a study on second language acquisition of English. 

Please share with your North American friends!

Si vous êtes un.e francophone québécois.e, veuillez considérer remplir ce formulaire qui prendra 15-20 minutes de votre temps. Le formulaire pose des questions par rapport à vos habitudes en anglais et fait partie d’une enquête sur l’apprentissage de l’anglais en tant que langue seconde.  

Je vous encourage à partager ce sondage avec vos ami.e.s québécois.e.s aussi!

THANK YOU // MERCI

[biomedicool]

Pneumonia

 “Pneumonia is called the old man’s friend because, left untreated, the sufferer often lapses into a state of reduced consciousness, slipping peacefully away in their sleep, giving a dignified end to a period of often considerable suffering.” -Dr John Pillinger

Pneumonia is a major cause of morbidity and mortality worldwide, the 6th largest cause of death in the USA. It is also economically costly in antibiotics, time off work, and hospitalisation

In half the cases the cause is not identified

In those where a cause is identified, S. pneumoniae is the most common cause

The reservoir is usually humans (oneself or a contact) 

spread is through respiratory droplets

Community acquired eg Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Mycoplasma pneumoniae, Chlamydia pneumoniae

Noscomial (hospital acquired) eg Enterobacteriaceae, Staphylococcus aureus, Anaerobes, Pseudomonas aeruginosa

Many patients have an underlying condition, e.g. bronchitis, asthma, a viral infection, tumours

Characterised by the alveolar sacs filling up with pus, giving rise to a purulent sputum

Symptoms

Results in chest tightness or pain, difficulty in breathing, fever or hypothermia, reduced blood oxygen, coughing to clear mucus, chest will sound “dull” when tapped, tachypnea, tachycardia (>100 bpm) or bradycardia (< 60 bpm), central cyanosis, altered mental status.

Streptococcus pneumoniae: Rust-colored sputum

Pseudomonas, Haemophilus, and pneumococcal species: May produce green sputum

Klebsiella species pneumonia: Red currant-jelly sputum

Anaerobic infections: Often produce foul-smelling or bad-tasting sputum

Diagnosis

X-ray showing infiltrates

Elevated temperature

Changes in WBC counts

Culture confirmation

Serum chemistry panel

Arterial/venous blood gas 

Serum free cortisol value and lactate level

Treatment

Intensive treatment, potentially to ITU level

Tailored antimicrobials if possible - limited options with viruses

Treatments include: analgesia and antipyretics, physiotherapy,  bronchodilators and N-acetylcysteine, suctioning and bronchial hygiene, ventilation 

Pathogenesis 

Causative agents can enter the lungs through inhalation, aspiration, spread across mucous membrane (some viruses), haematogenous spread (occasionally, e.g. IV drug users with S. aureus septicaemia) and penetrating injury (rare).

Immune response is triggered in the lung and there are local defence factors in the respiratory secretions

Cilia, if functioning, will move material up the respiratory tract, but if damaged this physical defence is impaired

The lungs also have a resident macrophage population (alveolar macrophages) but they are of limited use against several respiratory pathogens that possess a capsule

some organisms can even replicate in these cells

Damage to the lung is caused by the microbes and the immune response

 Enzymes released by the bacteria

Factors released by immune cells that cause local irritation and cell apoptosis

Systemic manifestations follow eg

Oxygen deprivation – thickening of the membranes reduces gas transfer

Systemic shock – especially with Gram-negative bacilli such as Haemophilus influenzae

[beyondtheoath]

Fuck them. Fuck them all. I previously have been a very measured voice of opposition, but now it becomes personal.

“Policy analysts at the Centers for Disease Control and Prevention in Atlanta were told of the list of forbidden words at a meeting Thursday with senior CDC officials who oversee the budget, according to an analyst who took part in the 90-minute briefing. The forbidden words are “vulnerable,” “entitlement,” “diversity,” “transgender,” “fetus,” “evidence-based” and “science-based.”

In some instances, the analysts were given alternative phrases. Instead of “science-based” or ­“evidence-based,” the suggested phrase is “CDC bases its recommendations on science in consideration with community standards and wishes,” the person said. In other cases, no replacement words were immediately offered.”

[md-admissions]

The fact that multiple reliable sources are reporting on this makes the veracity difficult to deny. The fact that basic terms I use on a daily basis to describe my patients, my work, the things I’m most passionate about will be censored at the highest level makes me sick. Agree with @beyondtheoath. Fuck. Them. ALL.

**edit

After cooling down a bit, I will now proceed all my representatives, and you should, too. If ever there was a sign that medicine must make a choice to become active in all this, THIS IS THE SIGN. PARTICIPATE OR BE COMPLICIT. 

[dxmedstudent]

We are all vulnerable due to the non evidence-based opinions and entitlement of policy makers who lack diversity, fear transgender people, and value fetuses only whilst they are in the uterus, at complete odds with a science-based understanding of reproduction or human rights.

Jokes aside, a lot of people are drawing parallels to Orwell’s 1984 and Newspeak. I recommend that everyone reads it; not fir thr plot but for the insight into cemsorship and how access to vocabulary can shape how people think. It’s hard to believe people are able to do this so brazenly. It’s a new low.

Don’t let them get away with it.

For those who are vulnerable and who are entitled to protection. For what is evidence and science based. Because a fetus is a medically accurate term for something which is not yet a baby or a person in law. For the transgender, whose existence cannot be magicked away by hiding a word. And because diversity is more than a word to many people; it’s their lives.

Use all the words.

Use every word to craft as nuanced and cutting a meaning as you can, they are tools nobody can steal from you. And consider this a call to action.

[eclipperton]

Yeah. I mean. These words were banned from documents pertaining to the budget. Probably then that means any money allotted to programs/research directed towards, say, transgendered people could be revoked. And the “recommended” language including “according to community standards” seems like a soft way to pretty much defund anything the repubs find objectionable. So. Great. Yeah. Let’s defund the CDC. Then next time there’s an Ebola outbreak we’ll see what happens.

[shrinkrants]

Secrets of Great Doctors  [ As seen everyday through the eyes of Nurses]

[nurse-x-ramblings]

1.  A doctor who, above all, respects the inherent worth and dignity of every patient regardless of socioeconomic status, disease, race, ethnicity, or personal judgments as imparted by another health care professional.

2. The doctors who do not dismiss the concerns, or instinct of a nurse, nursing student, or med student.

3. A doctor who isn’t afraid to admit when he/she is wrong; to the patient, the nurse or any student in their charge - and a beautiful sincerity in apology without blaming others for what they are responsible and accountable for.

4. A physician who respects students of all descriptions - med students, nursing students, PA students - perhaps likely remembering the beginning of their own journey. One that respects the inherent worth of all his/her colleagues from the housekeeper to the cafeteria worker.

5. A doctor who actually does their assessments, not just standing by the door, observing and charting inaccuracies.  Moreover, there is something memorable about the ones who not only anticipate quality of care, but the ones who take the time to listen intently to, and care for their patients.

6. A doctor who doesn’t embarrass, or make examples of a nurse, resident, or  med student during rounds when they answer a question incorrectly  - and actually takes the time to explain so there’s learning involved. (Not to mention respect of their knowledge and patience).

7. Physicians who understand that there’s sometimes a time to let go, despite any heroic measures, there’s insight of what would be best for the patient, over relentless  interventions.

8. A doctor who doesn’t come out of a patient’s room to ask a nurse/nursing assistant to put a nasal cannula on, fetch a glass of water, blanket or any basic items that a patient is also probably secretly wondering why they have to go get someone else to help me with something so simple; and while some of the more time consuming tasks are not expected - it’s always so very appreciated when one takes the time to assist a patient with positioning, or cleaning.

9.  Doctors who stand up for nurses to the Nursing Supervisors, or one who defends the nurses when a patient or family member is being disrespectful.

10. A doctor who on any given day, amid the overwhelming stress, chaos or fear will always find a little humor, and never lose sight of why they chose to honor their oath of care.

[shrinkrants]

(via medical-student) by way of aspiringdoctors

[infectiouslystudiousmd]

Ahhh I did well on my pharmacology exam!!

[simplyana1]

🥞