But where’s the lie? - Saber

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But where’s the lie? - Saber
Running pediatric calls. - Saber
To be or not to be [naked]...
Walked into my patient’s room to discover her lying in bed (still restrained mind you), butt naked. Trying not to stifle a laugh, I ask my very confused, delirious patient what on earth is going on: Nurse BCS: Ms. L, what on earth is going on here? Why are you naked? Ms. L ( with a befuddled look on her face, then looking at me like I’m the crazy person): … I’m not naked.
Nurse BCS:
Welcome to crazy town.
What if we all died in 2012 and this is actually just hell
Depiction of my unit while I am charge nurse:
I feel like all my charge nurse friends have this feeling when I’m on the clock. 😅 - Saber
When you’re so hungry (Source: http://ift.tt/2zzjWnv)
People who leave their elderly, demented relatives alone in the ER can go straight to hell.
I really, really wish people wouldn’t:
leave their relatives with dementia or any kind of chronic or acute confusion in A&E alone. We need to know what is normal for them; some people are confused as their ‘normal’, for others it is something entirely new. If we have no idea, we’ll have to assume it’s new, and your relative may even end up with inappropriate investigaitons or treatments because we had to play it safe. Not to mention that being in A&E is scary for them; please be there for your relative, don’t leave them to deal with being sick in a strange place all alone. It’s not fair to the patient or their clinicians.
leave their relatives who cannot speak English in A&E alone. Again, if they can’t understand, then it’s a scary situation for them. And we also find it hard to communicate with them or take a history. We can get a hold of translational facilities, but it takes valuable time that might affect their care.
Send in care home residents like the above with a care worker who does NOT know anything about how that resident has been doing the past few days. It’s not very helpful. We NEED to ask questions about whether someone’s been going to the toilet, eating, coughing, in pain, etc. and any carer coming with them to hospital should know this kind of basic information.
Bring in their kid, if they are the parent who has been at work all day/week and has no idea of how the kid as actually been doing at home. Again, things like eating, drinking, peeing, pooing, coughing, fevers, reporting pain, whether they are their usual self, are all standard information we expect a parent to be able to tell us. If you’re not the parent who’s been looking afterh them, then I’ll have to call the other parent up on the phone and ask them these questions, so it’d really help if you knew what was going on. I’m serious, I furnish my vet with more information about how the cats are doing, than I get from most of the above. Some nights in A&E, I have to see confused patient after confused patient, frequently left in A&E without anyone who knows what is normal for them. It makes working out what is going on a lot harder.
Tonight at 11:00:01, it’ll be exactly 59 days, 59 minutes, 59 seconds until the new year…which is 59 years since the year 1959.
Anime Med Student Problems…learning CPR realising you kind of suck at it.
Cardiac Arrhythmia Classifications
There is quite a lot to be said about the medications we use for patients with arrhythmias. It’s easy to get lost as to what drugs do what and how, but thankfully there was a kind enough person by the name of Vaughan Williams, who actually broke them down into separate classes. Each class effects separate parts of the cardiac cycle, ultimately changing the electrical current of the heart.
Cardiac Action Potential
Before looking at the medications, we have to understand the cardiac cycle and how it actually works.
Source: x
The above chart presents the four phases of an action potential in a ventricular myocardial cell and how the electrolytes are used to cause the depolarization and repolarization of myocardial cells.
Phase 0 begins with a slight influx of sodium until it passes the potential threshold. Once past the threshold, more sodium channels will open and flood the cell, causing it the depolarize.
Phase 1 is an efflux of potassium from the cell, causing the cell to reach 0mV.
Phase 2 happens at this point. This is when calcium influx happens, prolonging the repolarization period. This period also goes by the name of an absolute refractory period for the cell, since it cannot depolarize during this time.
Phase 3 Calcium channels close again and potassium continues to efflux from the myocardial cell until the internal cell voltage returns to -90mV. Majority of potassium channels then close and the heart enters phase 4, which potassium is allowed to continue to leak into from the cell.
This process happens anywhere from 60 to 100 times per MINUTE!
Vaughan Williams Classifications
The major purpose of the medications in this class effect they way the cardiac action potential works in the cells of the heart. The drugs usually help to slow down specific phase to the heart and allow the heart to fix itself a bit.
Class I - Sodium Channel Blockers
These medications are designed to disrupt phase 0, causing a prolongation of it. There are 3 subcategories (a,b,c) that are broken down into moderate, weak, and strong.
This article won’t go into great depths, but the major goal of the class is to prolong the QRS complex and prolong or shorten QTi.
Medications include:
Lidocaine
Verapamil
Procainamide
Propafenone
Class II - Beta Blockers (-olol or -alol)
Quite commonly used out of hospital for patients with hypertension, beta blockers are actually a common antidysrhythmic. The basic pharmacology is: by blocking the beta-1 receptor sites, it prevents stimulation of the cardiac muscle to beat faster. The increase of sympathetic tone will decrease the rate the heart will beat.
Medications include:
Propranolol
Metoprolol
Carvedilol
Class III - Potassium Channel Blockers
Similar to the Class Ia medications, potassium channel blockers are used to prolong APD, which can cause a prolongation of ERP. This class of medication is commonly known to treat different ventricular dysrhythmias (Vtach or Vfib). The most common medication for this class is Amiodarone and deserves a post of its own.
It’s most common use is during CPR, when the patient is in pulses Vtach or Vfib rhythm and is then followed by a drip with ROSC is achieved. An important note to make about Amiodarone is it can take 16 weeks to leave the system.
Medications include:
Amiodarone
Sotalol
Ibutilide
Class IV - Calcium Channel Blockers
Commonly uses for Afib with RVR and PSVT, a calcium channel blocker will prolong phase 2 of the action potion in the cell. The goal is to slow the conduction through the atrioventricular (AV) node, slowing the ventricular tachycardia that is occurring. By prolonging the ERP in the AV node, the heart is able to regulate the rate better.
Calcium channel blockers are commonly prescribed by physicians to assist in the care of such arrhythmias. One side effect of these drugs is it may drop the patient’s BP, so ensure you have an SBP >100 or a MAP >65, prior to administering the medication
Class V - Others
This is the mix bag class. These drugs do not truly fit in any category but are still highly important to mention anyways. Two of these medications are Adenosine and Digoxin.
Adenosine prevents the re-entry of a signal in a sinus rhythm, preventing SVT. A warning though is for patients that have WPW syndrome may cause an increase in heart rate instead, so make sure you’re reading the rhythm correctly.
Digoxin effects vagal tone and is seen less as an emergency drug and more as a maintenance drug for chronic heart issues. A major issue with this drug is it holds a very narrow therapeutic index. Toxicity is quite possible if given too much.
Summary
Each class works in its own way on the action potential in the cardiac conduction system. How they affect the heart greatly determines when and how the medication should be used in different medical scenarios. The point of this article is to help a bit with the pharmacodynamics involved with the medications and to hint at the situations a person in the medical field would use them?
Remember to check out my facebook page. Feel free to send suggestions for possible article ideas, it might pop up some time. Always remember that medicine is an art, just as much as a science.
Sources:
In case you can’t read it: Q - “Are we running low on anything?” A - “Will to live.” Same, bro. Same. 😂 - Saber
Fun fact, there is NO recorded cases of children’s candy ever being harmfully tampered with nor causing harm/death. Have fun, kids! 🎃 - Saber
Me: *pouring fabric softener*
Brain: drink
Me: ??? no???
Brain: smell nice. drink
Day crew rolling in be like... 😎😂 - Saber
Once my friend Henry was accused of wearing wireless headphones by a substitute so she said for him to hand them over so he took them off and handed them to her. Then later on she asked him a question and he didn’t respond so she said it louder and he still didn’t respond. She asked why he was not responding and he said “I can’t understand you ma'am, you took my hearing aids.”
HOLY SHIT
one time we had a sub that was handing back papers and called my name. I asked if someone could grab it for me and she started mocking me for not even standing up. taunting me asking why I was not walking up to the front to get the paper myself.
my classmates went dead silent and after the sub’s laughter ended someone informed her that the wheelchair parked nearby belonged to me
I had a sub in English once, on presentation day. And everyone goes up and does their thing, and then its my turn. The whole time im stuttering and mixing up my words, having to stop and re-say my sentences. The rest of the class is used to this and claps. However, by the time its over, the teacher is 100% done.
Starts saying horrible thing about how im going to have to get over my ‘fear of public speaking’ and how she’s heard 8 year olds give better presentations (plus worse things but I don’t really member them). By then im in tears and on the brink of a panic attack, and then she starts telling me off for crying The rest of the class is horrified. Then this boy stands up. He never been my friend and we never really got along, but he’d never bullied me. He told her in a pissed off, cold voice that in freshmen year I got a concussion and that I never really recovered from it, so all that was medical related and I couldn’t help it. Then he starts telling her off and the rest of the class joins him. The teacher is mortified and tries to cover her ass, but the whole class walked out and that boy took me by the shoulders and we all walked to the principles office and told him what had happened. Lets just say she isn’t teaching anymore. Also, turns out that boy had a sister like me, who couldn’t really speak. We’ve been best friends for 8 years and i’ll be his best woman at his wedding next year. The moral is that Teachers, even subs, and adults shouldn’t scold kids before knowing the whole story, because shit like that can fuck up kids self-esteem for the rest of their life.
Ummmmmm