Oh god, I have to study! @uptomyeyebrows - Tumblr Blog

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Hello, IT?

*ring ring*

Me: Hello, this is haematology?

Caller: Is the system down?

Me: *frantically brings up LIS program* Ah, no I don't think so? Do you mean (LIS)?

Caller: Its not working, I clicked on the "e" on the screen. It's at the bottom. The system is down.

Me: Like, internet explorer?

Caller: Yeah, it's not working!

Me: Sir, this is the haematology lab, IE is working for me, but you need to call IT

Caller: Are you sure?

Me: *sitting in front of microscope, analysers alarming, blood everywhere* Yep, I'm sure, good luck with your computer

#mistaken identity

Sometimes they die

I know it's not the same as families, or front line folks, but we know those patients too.

I wrote your name 15 times the first time we saw you, making the training set of films, hoping you'd get treatment and get better.

We kept an eye out for you, memorized your cells, looked at your file with a certain fondness.

You were gone for a while. Getting better? At the children's hospital? Home on hospice?

But you came back, and it looked worse. Trending down. On call doctor not even surprised at your critical results.

And then the samples stop. Maybe the doctors tell us you're gone, maybe they don't and we keep wondering.

All we knew of you was some blood in a tube, but it still breaks my heart to know that you've gone for real.

#tw death #pathology #medblr #pathblr #laboratory #sad #its just sad that we never meet these folks #but we know so much about them #and then they die #hospital

uptomyeyebrows

Blood cancers - a basic overview that really helped me piece things together

uptomyeyebrows

The fact that I had to relearn all of this indicates that I did not piece things together as stated

uptomyeyebrows

Soo

Im considering a career change to nursing. I’ll have my biomed sci degree at the end of this year, so I would take a year to work and maybe get settled in a new university town (or stay where I am), then start a graduate entry Program January 2019ish.

Advise? Nurblrs, how do I know nursing is for me? How did you know nursing was for you? I like the career path (or that one actually exists), I like the idea of working rural, or with the RFDS or Careflight. I just wanna do something good.

Help me tumblr

uptomyeyebrows

So update on this, nursing is very much not for me. I would have given up 3 minutes into my first placement. I like my patients well and/or at a distance

Respect to nurses, y'all have a hard job (pandemic notwithstanding) and have got hearts of gold

I was a nursing assistant for 18months, and I noped the heck outta there as soon as I could. Our patients weren't even sick!

Reviving the blog!

I know that no one is on Tumblr any more, but I've got random stories and gripes from my work that maybe I could share (v. Deidentified of course).

So I'm moving from a shitty studyblr to a shitty jobblr/scienceblr/haemblr/pathblr (is -blr still the right thing to use? It's been 5 years y'all)

So, yeah, hello again!

#revival #studyblr #heamblr #pathblr #scienceblr #pathology #haematology #science #medicine #vaguely medblr

medschoolgeek

This is how heart works <3 <3 <3

microaerophilic-blog

Pseudomonas aeruginosa on sheep blood agar.

a gram negative bacillus/cocci bacillus. some of of the standout characteristics of some pseudomonas are the metallic sheen of the colony morphology, and often a grape-like or musty corn tortilla odor (this had the latter).

pseudomonas is a cause of UTI’s, wound infections, ear infections, and can be a big issue for patients who are immunocompromised (especially patients with cystic fibrosis).

medical-lab-minds

Oxidase Positive too.

medicalwhoregore

Klebsiella on the left, ecoli on the right. Chromogenic media for urinary tract pathogens read at 24hrs from an O2 incubator set at 35 degrees.

And as an FYI gloves are not worn in microbiology unless you are working with direct specimens like setting up blood, feces, or sputum on agar plates which is done in an entirely different area of the lab and in a biological safety cabinet that is HEPA filtered. Once plated the bacteria that grows is not considered dangerous for you to work on without gloves on your bench top. (Unless for example the specimen has gram negative dipplococcus in the direct smear from a spinal fluid which would indicate meningitis)

regionstraumapro

EAST 2018 #2: Blood Product Age And Mortality

Ever since the start of the modern transfusion age (which was really only about 75 years ago), we’ve been trying to extend the life of banked blood products. Currently, we get about 6 weeks of useful life from packed red blood cells, and varying amounts from other frozen or non-frozen products.

What happens at day 42 for red cells? Or day 5 for platelets or thawed plasma? It’s not like a switch gets flipped and it suddenly goes bad. Each of these products slowly degrades over time, and the myriad components that make them up (proteins, clotting factors, etc) do so at varying rates. It has been recognized for years that some of these products “don’t work so well” when they age, and this has been termed the “storage lesion” of blood.

The next EAST paper I’ll review looks for associations between use of older blood products which probably have a storage lesion, and mortality in trauma patients. It re-analyzed the prospectively collected data on the 680 patients enrolled in the PROPPR trial, which was originally designed to examine the mortality difference between patients with specific FFP:platelet:PRBC ratios given during massive transfusion. In this re-analysis, the authors looked at the mortality after 6 hrs, 24 hrs, and 30 days in patients undergoing massive transfusion, and examined the impact of using “older” blood products. “Old” was defined using the median age of the product; RBCs were old after 20/42 days, plasma after 2/5 days, and platelets after 4/5 days.

Here are the factoids:

Plasma age decreased with increasing transfusion. There was no similar change in average platelet or RBC age, though.

Patients receiving older RBC and younger plasma had higher mortality

Receiving older PRBC was associated with mortality at 6 and 24 hrs, but not 30 days

Bottom line: First, this is an association study, not a causation one. Don’t read anything more into it than you see. And what do you think when you see random mortality numbers like this? For me, either mortality is too crude of a variable to use, or the association is just too weak. If you look at the data table for the study, the confidence intervals of the computed “hazard ratios” barely clear the 1.0 line. To me, this looks like an interesting mathematical exercise, but I can’t tease any clinical significance out of it at all. And I don’t think that re-analyzing this dataset will provide any further clarity.

Here are some questions for the authors to consider before their presentation:

Did you try to calculate the statistical power of your dataset? As mentioned above, the associations look weak at best.

Did you look at other potential factors like injury severity score or massive transfusion volumes? These would seem to have a much more significant impact on the three survival cohorts?

Big picture questions: Where can you go from here? What kind of study could you do to see if this is a real effect vs just a statistical anomaly?

Reference: EAST 2018 Podium paper #3.

Source: http://thetraumapro.com/2017/12/26/east-2018-2-blood-product-age-and-mortality/

jewsee-medicalstudent

Human heart in ventricular fibrillation.

Ventricular fibrillation is a condition in which there is uncoordinated contraction of the cardiac muscle of the ventricles in the heart, making them quiver rather than contract properly. It is the most commonly identified arrhythmia in cardiac arrest patients.

While there is some activity, the lay person is usually unable to detect it by palpating (feeling) the major pulse points of the carotid and femoral arteries. Such an arrhythmia is only confirmed by electrocardiography.

Ventricular fibrillation is a medical emergency that requires prompt Advanced Life Support interventions. If this arrhythmia continues for more than a few seconds, it will likely degenerate further into asystole (“flatline”). This condition results in cardiogenic shock and cessation of effective blood circulation. As a consequence, sudden cardiac death (SCD) will result in a matter of minutes. If the patient is not revived after a sufficient period (within roughly 5 minutes at room temperature), the patient could sustain irreversible brain damage and possibly become brain-dead, due to the effects of cerebral hypoxia. On the other hand, death often occurs if sinus rhythm is not restored within 90 seconds of the onset of VF, especially if it has degenerated further into asystole.

Causes of ventricular fibrillation are:

Abnormal automaticity: In the healthy myocardium, the rhythm of contraction is regulated by sinoatrial node,that acts like a pacemaker and generates the normal sinus rhythm. Automaticity is a measure of the propensity of a fiber to initiate an impulse spontaneously, separated from the sinoatrial node. The product of a hypoxic myocardium can be hyperirritable myocardial cells and these may then act as pacemakers. The ventricles are then being stimulated by more than one pacemaker. Scar and dying tissue is inexcitable, but around these areas usually lies a penumbra of hypoxic tissue that is excitable. Ventricular excitability may generate re-entry ventricular arrhythmia. It is interesting to note that most cardiac myocardial cells with an associated increased propensity to arrhythmia development have an associated loss of membrane potential.

Re-entry: The role of re-entry or circus motion was demonstrated separately by Mines and Garrey. Mines created a ring of excitable tissue by cutting the atria out of the ray fish. Garrey cut out a similar ring from the turtle ventricle. They were both able to show that, if a ring of excitable tissue was stimulated at a single point, the subsequent waves of depolarisation would pass around the ring. The waves eventually meet and cancel each other out, but, if an area of transient block occurred with a refractory period that blocked one wavefront and subsequently allowed the other to proceed retrogradely over the other path, then a self-sustaining circus movement phenomenon would result. For this to happen, however, it is necessary that there be some form of non-uniformity. In practice, this may be an area of ischaemic or infarcted myocardium, or underlying scar tissue.