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@whereismystethoscope
Infant girl with Whooping cough
Whooping cough (pertussis): is a highly contagious respiratory tract infection. In many people, it’s marked by a severe hacking cough followed by a high-pitched intake of breath that sounds like “whoop.” Before the vaccine was developed, whooping cough was considered a childhood disease. Now whooping cough primarily affects children too young to have completed the full course of vaccinations and teenagers and adults whose immunity has faded.
Deaths associated with whooping cough are rare but most commonly occur in infants. That’s why it’s so important for pregnant women — and other people who will have close contact with an infant — to be vaccinated against whooping cough.
Repost from🎥@twas_medical
#cough #whoopingcough #child #pediatrics #infection #disease #video #instavideo #usmle #usmlestep1 #usmlestep2 #doctor #doctordconline #nhs #nurse #nursing #hospital #patient #mbbs #md #amc #plab @doctordconline
Kidney stones (renal lithiasis, nephrolithiasis) are small, hard mineral deposits that form inside your kidneys. The stones are made of mineral and acid salts.
Kidney stones have many causes and can affect any part of your urinary tract — from your kidneys to your bladder. Often, stones form when the urine becomes concentrated, allowing minerals to crystallize and stick together.
Passing kidney stones can be quite painful, but the stones usually cause no permanent damage. Depending on your situation, you may need nothing more than to take pain medication and drink lots of water to pass a kidney stone. In other instances — for example, if stones become lodged in the urinary tract or cause complications — surgery may be needed.
#kidney #kidneystones #laparoscopy #laparoscopysurgery #surgeon #surgery #renallithiasis #nephrolithiasis #nephrology #pathology #usmle #university #usmlestep1 #usmlestep2 #doctor #doctordconline #instavideo #video #hospital #hospitallife #patient #medvideos #mbbs #md #amc #plab @doctordconline
Tumor is removed using Computer-assisted neurosurgery. Computer-assisted neurosurgery is based on the use of computers to perform minimally invasive neurosurgery. Stereotactic (from Greek: Stereo-three dimensions; tactic-to probe) is a term to describe a procedure done in precise and defined three dimensional space using a computer system.
Heart murmurs mnemonic
Hello people with a pumping heart in their chests, obviously! <3 In this post, I’ll be taking about the few mnemonics I use in relationship to murmurs. “PASS” is a good mnemonic for remembering that pulmonic and aortic stenosis give a systolic murmur. The opposite of PASS, ie, other two valves and the other defect gives a systolic murmur too. (Mitral and tricuspid regurgitation gives a systolic murmur!) VSD has a S so that’s systolic. Now, the other ones - pulmonic and aortic regurgitation, mitral and tricuspid stenosis will cause diastolic murmurs :) Here’s another mnemonic submitted by one of the readers: For the systolic murmurs: MR. P.V. TRAPSS (Mister Per Vaginum traps? :P) MR. P. - Mitral Regurgitation or Prolapse V. - VSD TR - tricuspid regurg APS - Aortic or Pulmonary Stenosis S - Systolic For the diastolic murmurs: MS. PAID MS - Mitral Stenosis PAI - Pulmonary or Aortic Insufficiency D - Diastolic Here are a few more lame mnemonics I made when I was in final year! =) I remember GDP or Gross Domestic PRoduct. Graham Steel murmur is a Diastolic murmur associated with Pulmonary Regurgitation. Alternatively you can remember, Graham SED PR (Graham said per rectum? xD) For Graham Steel, Early Diastolic, Pulmonary Regurgitation.
Carrey Coombs murmur is seen in rheumatic carditis. “RCCC (Renal cell carcinoma) is diagnosed by MD and MS”, is my mnemonic. Rheumatic carditis, Carrey Coombs, Mid diastolic, Mitral Stenosis. Austin flint murmur is seen in aortic regurgitation. “AFAR MD” helps me remember Austin Flint, aortic regurgitation and Mid Diastolic. I am actually not a fan of using mnemonics for concepts like murmurs. But once, I was asked to name systolic murmurs in a viva. And you know how vivas are, if you don’t answer quickly, another question is thrown at you. Luckily, I remembered this mnemonic that day and could answer quickly. That’s when I realized, it’s okay (It’s awesome, actually!) to understand all the murmur mechanisms properly when you have time to imagine at home and it’s definitely okay to use mnemonics cheaply when you don’t have time to think, that is, in time bound exams. That’s all! Lub dub goes my heart… -IkaN
Heart Blocks
Glucose in pleural fluid analysis
Hi :) A low pleural fluid glucose concentration (less than 60 mg/dL, or a pleural fluid/serum glucose ratio less than 0.5) narrows the differential diagnosis of the exudate. Causes of low glucose in pleural fluid include: Rheumatoid pleurisy Complicated parapneumonic effusion or empyema Malignant effusion Tuberculous pleurisy Lupus pleuritis Esophageal rupture You don’t need to memorize the causes if you know the mechanism: The cause of low pleural fluid glucose is increased utilization of glucoseby constituents of pleural fluid, such as neutrophils, bacteria (empyema), and malignant cells. The lowest glucose concentrations are found in rheumatoid pleurisy and empyema, with glucose being undetectable in some cases :O Did you know? Pleura came from the word Pleuron which meant the side wall of each segment of the body of an arthropod. Pleuron was a singular word and pleura was the plural form. But we started using pleura as a singular word for both pleurons… And pleurae is now the word for plural pleura :P That’s all! Say something nice to yourself today :) -IkaN
Ice or Heat?
THIS IS SO INFORMATIVE!
I get asked this question at least twice a week. So here ya go.
Removing a HUGE kidney Stone!
Emergency hospital at Dartmouth, Great Flu Pandemic, 1918.
CHEST PAIN
A 32 year old male, resplendent with hipster beard and braces, attended A&E late on Sunday night with ‘central chest pain’.
Not too willing to reveal all of his symptoms nor past medical history, he appeared to want to follow the train of thought of the Doctor.
Agonising discussions about the exact location of the pain, radiation to other locations, associated symptoms of nausea, diaphoresis and palpitations and family history elapsed.
The doctor then asked if it hurt when he pressed on his sternum or the joints of the ribs around it; costochondritis is an important differential diagnosis in chest pain. It is a viral inflammation in those joints.
“Ah”, exclaimed the patient, knowingly. “You’re trying to detect whether I have achondroplasia.”
This is the medical name for dwarfism.
“You’re six foot one,” the doctor replied. “I’ve already ruled that out”.
Puzzled, the patient finally divulged that in a bid to get fit he had attended the gym the previous day for the first time in several years and had used weights extensively especially in order to develop his pectoral muscles.
In order for his braces to fit better.
WHY ARE YOU IN HOSPITAL?!
SWEATY FOOT ?INFECTION
A 26 year old male presented to the ED with a sweaty foot.
A sweaty foot.
He was worried that it could be infected.
It was not hot, red or inflamed.
He was not experiencing fever, nausea or vomiting.
He just had a sweaty foot.
On examination he had a sweaty foot. He also had another sweaty foot.
Diagnosis: bilateral sweaty foot.
The patient was disgruntled that he had waited for 3 hours to be seen by a Doctor and immediately sent home.
WHY ARE YOU IN HOSPITAL?!
SHORTNESS OF BREATH
A morbidly obese 67 year old male experienced shortness of breath when racing to the top of the stairs and arrived in A&E by ambulance.
It lasted for approximately one minute before spontaneously resolving.
There were no other symptoms.
He had not exerted himself physically for over a year.
“I counted my pulse when it happened,” the patient said, helpfully. “It rocketed to 92! It’s never normally more than 88.”
WHY ARE YOU IN HOSPITAL?!
Flasks of different colored urine, used to teach medieval doctors how to diagnose illness. In addition to color, doctors would check the smell and even taste the urine to determine what illness a patient was suffering (c.1400) British Library (Sloane Ms 7)
The NHS and the Reality of the New Junior Doctors' Contract.
I am a junior doctor who works in the Accident and Emergency department of a Midlands’ hospital.
It’s a hard job, like many within the hospital. The pressures on the staff and the department itself are considerable.
Over the past months, with the evolving dispute surrounding the contract for junior doctors, I, like my colleagues, have watched with intrigue. Intrigue has made way for indignation, disappointment and anger.
We have tried to remain professional despite the thinly-veiled attacks on our integrity and sense of vocation, our outrage cemented in false statistics and sensationalist reporting designed purely to denigrate the NHS and every single person who works within it.
The furore has dimmed somewhat since the announcement of imposition of the new contract, in the media at least. This has at least given us all time to reflect on what has happened.
I have read as many articles and posts from as many different sources as I have been able to. Many are in support of the juniors and the NHS as a whole whilst some have demonised the BMA. Others have tried to simplify this action to a pay dispute.
I’d like to try to describe my last week to you and explain why this is a dispute about something else entirely.
This is about life.
It is about providing the opportunities for patients to have their lives cared for, adequately and professionally, so that they can leave the hospital in a better situation than when they arrived.
This is about fuller and happier lives for the families of those patients who can build new memories, enriched by the presence of a loved one.
And it is about life for the people providing that same care.
We need the environment and the system in which to optimise the delivery of the care we are capable of giving in order to save lives, improve them and empower them. It’s what we strive for every day.
We also need the environment to balance our own working lives against our need for social interaction, rest, learning, adequate nutrition and maintenance of our physical and emotional health.
Without this, it is not possible to offer the best care that any of us can hope to provide.
And that is a travesty for patients.
From last Saturday (20th Feb) in seven days, I was Rota’d on for 72 hours. This comprised of:
Fri 19th: off Sat: 14-0200 Sun: 14-0200 Mon: 12-21 Tues 12-21 Wed: 2200-0800 Thurs: 2200-0800 Fri: 2200-0800.
In reality, I worked nearly 85 hours.
On Sunday evening I left work at 0340, got home at 415, went to bed at 0500 and was up at 0930 before another 10 hour shift that turned into twelve hours.
I had one proper break all week- that is, half an hour to sit and eat a sandwich and have a cup of tea. I had one proper meal.
I missed my scheduled teaching for the week because I was on nights. I had a meeting on Thursday morning after my night shift to discuss why I had missed so much teaching and the extra e-learning I would need to do in order to compensate for this, as well as that already required that I was yet to complete.
I crashed my car on the way home.
That night I led the care of a seven week old in cardiac arrest due to an undiagnosed narrowing of their aorta and a hole between the atria in their heart. We were successful.
The other patients I remember from the week were a gentleman who I told required further investigation because he had a brain tumour; a lady on chemotherapy who had an overwhelming infection; a 10 year old with a life-threatening asthma exacerbation; and a lady who had been hit with a hammer in the eye.
We were so busy one evening we had someone with a supraventricular tachycardia, another with a bowel obstruction and another with a diabetic ketoacidosis in the waiting room- we just had no space to put them into a room.
These people were critically unwell and there is an energy that comes with that. This is what we are trained for. This is what we do.
The patients that turn out to be more difficult when you are tired are those inbetween; blood results unremarkable, imaging without abnormality, but distinguished clinical signs.
Send home or admit? GP follow up or medical review? Non-specific abdominal pain or appendicitis?
When you are tired, the mistakes lie here. In the grey areas. And it is so easy to miss.
For example: A man comes in with a respiratory tract infection. You treat it. He is epileptic. You refer him, and he is to be transferred to a medical bed. You are not informed there is a delay in transferring him to the ward. He doesn’t receive his regular medication because you didn’t prescribe it in your rush to see the next patient. The nurse tells you and they prevent a fit. You feel awful; but until you see his face you can’t even remember him because you’ve seen 10 patients since and numerous relatives.
1g of paracetamol prescribed; but the patient is 45kg and you didn’t check. She should have had half that. My colleagues prevent me overdosing her.
I enter the department each day and look at the bed board and hope I don’t recognise any names of patients that I treated the day before.
I’m tired when I start.
We finish late on shifts because we can’t leave these patients. We aren’t clock-watching.
It is not straightforward to hand over the details of a case to a colleague and ask them to contact intensive care. It is better for the patient that we do it ourselves; so that is what we do.
Sometimes, there is nobody to hand over to. So we stay on. Because that is what we do. That is what is right.
We don’t take breaks so we can tell your relatives your blood tests results and the likely course of a new diagnosis or life event. That is normal.
We do this in an increasingly litigious society where our mistakes are magnified and we are punished, rightly, for our errors. Twice this week my consultations have been recorded by relatives, once without my knowledge at the time.
Is that right?
Is any of this right?
Is it right I am being pushed more and more by my seniors, by my health secretary, by my government?
Is it right that I am in increasingly difficult environments that make it more likely that a patient will come to harm? More likely that I will end up in court with the coroner? More likely that my career will stall? More likely that my health will be affected?
I go on holiday in my fixed annual leave and realise it is the first time I have had to process the cries of the woman I comforted after we lost her 5 month old daughter on Boxing Day. A week after she had lost her husband in a motorbike accident.
I remember the 11 year old who tried to resuscitate her 42 year old mother. We couldn’t save her. She wouldn’t let me go when I told her and I watched her grow up in front of my eyes as she comforted her father when he arrived and was so stricken with grief he couldn’t get up from the floor for an hour.
I need to be alert, well-rested and healthy. For these patients and these relatives, they deserve for me to be at my best.
And I need to be at my best for me too.
I do this job so families and friends can share more precious moments together. My chosen career doesn’t afford me the same opportunity.
If the new contract is, as planned, imposed in August, this week will be more normal for my colleagues.
Being at my best will be impossible.
And despite not agreeing that the care I provided last week deserved the £6.54 per hour (£5.40 if calculated under the terms of the new contract) I received, that is not what our profession is concerned with.
For patients and all healthcare staff, this contract is morally, ethically and fundamentally wrong.
I get really confused when americans, when talking about universal health care are like ‘yeh but it’s not free sweaty :) :) you have to pay it through taxes :) so gotcha!!’
and I’m like ….???? That’s the whole point??? Everyone pays their fair share so that no one has to be turned away because they don’t have insurance??? And no one has to set up a Fundraiser page just so that they DONT DIE???? So people don’t put off going to the doctor because they’re scared of going bankrupt?? Because healthcare is a RIGHT and should be free at the point of access?!?