The Tables Have Turned

So two nights ago I ran to the emergency room, but not in an ambulance. It was for myself. Around 2200, I had a sudden onset of pain in my abdomen, just above the navel. The pain then radiated down my right side and into my right lower quadrant and eventually into my groin. I palpated my abdomen and sure enough, it was tender down in the RLQ. I was guarding against my own touch. It was different from the other three quadrants where I was not tender and not guarding. “Great,” I thought to myself, “Appendicitis.”

So I decided to call the insurance company’s nurse hotline. She suggested that I go to the ER as soon as possible since she agreed with me that it could be appendicitis. So I went to the ER and was first in line to go in for treatment. Appendicitis is something to be taken seriously. After a while the pain got more and more intense and a CT scan was scheduled for me.

Ah, you have no idea how much torture a CT scan is. I had to drink one and a half canisters of Barium, let me tell you that was not fun. There is not a worse flavor in the world, period. So after stomaching that I went to the CT scanner where they hooked my IV line up to an iodine solution. That really felt weird, and yet cool at the same time, because I could feel the heat that it created in a reaction with my body all down my back and in my throat (I assume at the thyroid.) CT scan was done, and I was taken back to my room in the ER. The radiologist was then sent my information but could not read it because the Barium had not finished absorption at my appendix. So I had to return to the CT scanner for another attempt. I’m surprised I’m not glowing in the dark. Luckily, the radiologist was able to read this one and saw what she described as early acute appendicitis. A general surgeon was then called in.

After a while the surgeon arrived. He agreed to remove the appendix. I asked how long he thought the surgery would take and he gave me a valuable piece of advice, which I will always remember and will hopefully repeat someday. “A good surgeon will never give you a certain amount of time. I will take the time to do a good job.”

An hour later I was being prepped for the open appendectomy. I will take the opportunity now just to say that all the staff that I have encountered was absolutely amazing; you couldn’t have asked for better healthcare providers. There was both an anesthetic and an anesthesiologist who told me what they were going to do when I entered the room. The next thing I know, I was wheeled into the operating room, a mask was put over my face. They said it was just oxygen and then I assume they pushed the drug because I woke up in the post-operative ward. I don’t remember a thing about the surgery and I don’t even remember being wheeled into the OR. After the surgery they made sure that I was in no pain. I appreciate everything they did for me. The nurse told me that the general surgeon had said that the appendix was on the verge of bursting. That would’ve been bad, very bad. A septic nightmare. Thanks again everyone for everything that you’ve done.

After that I waited in the post-op ward for a couple of hours, sleeping off and on while they tried to make room for me on the med-surg floor. That’s where I am now, writing about it on the laptop. I’m on an antibiotic now for prophylaxis and also lactated ringers and 5% dextrose which is running into me now at 100mL/hour.

They call me the “doc” here and “EMT.” I took an interest in reading my own EKGs. Their machines show U waves! My vital signs are currently: blood pressure (BP)- 98/58 and pulse- 106. Guess that means I’m in compensated shock considering my normal BP is 114 systolic and my usual pulse is 64. I’m going to be out of action for a while. That means no power-lifting (that’s what we call the technique we use to lift our patients) for me for a long time.
I’ve still got to see if they’ll let me keep the appendix in a jar. Some hospitals will let you, but I doubt they will at this one. They’ve probably already gotten rid of it.

"Healthcare"

Last night I had duty. We were dispatched for a patient complaining of chest pain at the local long-term "healthcare" facility. If you can even call what they do there healthcare. In case you couldn't tell, I was really annoyed by the staff that received us when we got there. They didn't even actually receive us.

We showed up, lights and sirens, air horns blasting and went to the ambulance door. We knocked on the door and rang the doorbell thing they have there. No response. We repeat the process. We've now been standing outside the door for five minutes. Finally, a VISITOR opens up the door. We walk in and there's the nurses all standing around doing nothing. They had totally ignored us. We see our patient sitting in a chair (or what we assume is the patient, the staff still has not told us anything). We approach her and, as we approach, one of the nurses grunts that she is a visitor. None of the nurses offer any help to us at all.

The patient then leans out of her chair and tries to lay on the ground; we let her. I go back out to the truck to get the stretcher and have to get another visitor to hold the door open for me so that I can get back in. Nobody at the facility would help except the visitors. I'm really angry about this, but then again this place has a reputation for it. I would never send a family member there.

Overall though, I had a good night. That was our only call and I was able to get all my homework done and I also was able to go to bed early. I need the sleep, especially since I think I now have a cold and the four or five hours of sleep I get per night has been wearing on me.

Today I'm getting my TB shot checked. No bump has formed and it's now been 48 hours, so that's good.

News/Articles in the Rest of the World:

EU influenza pandemic preparedness

"EU preparedness against an influenza pandemic has improved over the last six months, but Member States need to step up their efforts to strengthen their pandemic preparedness, according to Markos Kyprianou, European Commissioner for Health and Consumer Protection.
The European Commission is preparing a number of initiatives which aim to help Member States co-ordinate their actions in this regard. There will be an EU-wide command post exercise to simulate a flu pandemic and the publication of a revised policy paper on pandemic preparedness before the end of the year. The Commission and the European Centre for Disease Prevention and Control (ECDC) have also been reviewing Member States' national plans ahead of an informal meeting of EU health ministers (20-21 October in Hertfordshire, UK) and a European Commission - ECDC - WHO expert conference (24-26 October in Copenhagen), both of which will discuss pandemic preparedness. "

Comparison of the risks and benefits of fish consumption

"A comparison of the risks and benefits of fish consumption suggests that government advisories warning women of childbearing age about mercury exposure should be issued with caution.
The study warns that if advisories cause fish consumption in the general public to drop out of fear about the effects of mercury, substantial nutritional benefits could be lost. The study will appear as a series of five articles in the November issue of the American Journal of Preventive Medicine.
"Fish are an excellent source of omega-3 fatty acids, which may protect against coronary heart disease and stroke, and are thought to aid in the neurological development of unborn babies," said Joshua Cohen, lead author and senior research associate at the Harvard Center for Risk Analysis at HSPH. "If that information gets lost in how the public perceives this issue, then people may inappropriately curtail fish consumption and increase their risk for adverse health outcomes." "

Well, I'm out, stay safe everyone,
Bravomedic

Direct Hit!

Okay, so I'm getting slammed this week. Tests everywhere, quizzes everywhere. So much to worry about and study for.

There's one thing that keeps me going, well, two things. Taking everything day by day for one. "Live to fight another day." The other is that passion for medicine. I don't care that I have to pull all-nighters to study for a test. If it means that I get into med school one day, and get to pursue my dream of becoming a physician then it was worth it.

I also acknowledge that what I have typed may also be incoherent. That's a side effect of fatigue.

In other news, I pulled duty last weekend. Not a whole lot, happened; just one call, which wasn't really bad off. We were dispatched for an "eye injury." Patient had gotten hydrogen peroxide in her eye. I've done this myself (using AOSEPT with my contacts) and let me tell you. It really hurts, you literally have to force your eye open; it's not easy to do because the eyelid goes into spasms that force the eye closed. It takes some real self control to get it back open on your own; I know it took me a while to do it myself before I could rinse it out.

This patient apparently wasn't so lucky. She couldn't open her eye so I had to grab the eyelid and force it open. I know that sounds terrible, but it has to be done, you have to get that stuff out of there. It's only going to do more damage in there. You'd be amazed just how strong the eyelid actually is, it takes a lot of force. I pulled it open and poured a 0.9% NaCl (sodium chloride or 'salt') solution in so that it flushed from the medial part of her eye to the lateral part. After thorough flushing we transported. I spiked an IV bag and hooked it up to a drip set and some IV tubing and used that the rest of the way to flush her eye. Everything turned out well. Not terribly exciting, but oh well. Not everything is.

Well, I have some more studying to do for AP US History and AP Biology.

Goodnight everyone, and remember, stay safe,
Bravomedic.

Studying...

Tomorrow I have my AP Biology test. That's going to be fun...wish me luck. So many darn names to remember with cristae, and thylakoids, grana, stroma, microtubules, microfilaments, intermediate fibers, desmosomes, what the smooth ER produces vs the rough ER. Plus what protein makes up each, such as microtubules are made up of tubulin, microfilaments are made up of actin, and intermediate fibers are made up of keratins. I plan on rereading my notes and rereading our labs.

I have duty Friday night, that's at least one thing I can look forward to it and it lasts until Saturday. Maybe there will be some action. Last Friday's game was absolutely miserable, even beyond miserable. Our team was winning until the end of the third quarter. Add to that, it was raining, and when it wasn't raining, it was just misting. Everything was wet, there wasn't a whole dry spot in the entire area, even in the inside of the ambulance was wet from us entering and exiting it. I'm glad that I don't have to do that again.

In other news:

Avian flu vaccine against H5N1 strain to be tested on humans next year after promising tests on birds, Vietnam

"After carrying out successful bird flu vaccine tests on birds, Vietnam will probably carry out tests on humans next year. The vaccine protects against the H5N1 strain of bird flu, the most virulent one. Tests started in April, 2005. Results have been successful on monkeys as well. The vaccine has been developed by Vietnam's National Institute for Hygiene and Epidemiology. It is applying to authorities for trials on humans. It is also seeking approval for the production of vaccines."

Ibutilide Appears Safe, Effective for Treatment of Atrial Flutter or Fibrillation in a Pediatric Setting: Presented at AAP

"WASHINGTON, DC -- October 12, 2005 -- Ibutilide, an intravenous agent approved to treat atrial fibrillation and flutter, appears safe and effective in a pediatric setting, according to a study of 19 patients who received a total of 53 doses of the drug.Though the research team used a more stringent definition of treatment success than that used in the initial clinical trials of the drug and required patients to convert to normal rhythm within 45 minutes, the study showed success rates close to or better than those seen in the drug's registration trials."

Atrial flutter is a pretty easily recognized rhythm, on an EKG it shows up with its classic saw-tooth pattern. Atrial fibrillation is also pretty easily recognized, just kind of hard to describe; it looks like a lot of artifact if you know what that is.

I'm out, stay safe everyone,
Bravomedic.

It's Finally Friday!

Free again...I always think of that song on Fridays. Tonight I'm covering the football game for my high school. I'm not sure if it's going to make or not due to the weather. If it does, I'll let you know how it turns out.

I still need to clean up my trauma shears from the last game. I was too tired to clean them up last week. I also have duty this weekend, more fun.

School dinner kids healthier than packed lunch kids, UK

"Researchers from St George's University of London examined the eating habits of one thousand secondary schoolchildren in England and Wales and came to the conclusion that school dinners offer better nutritional value than most packed lunches. The researchers said the nutritional problem may be more in the home than at school."

Apparently this is only in the UK. Here in America, I seriously doubt that there is anything more unhealthy than the school lunch. It's preserved in grease (not that grease is bad, it adds flavor.)

Drug can reduce risk of death, heart attack, and stroke in patients with diabetes

"A diabetes drug called pioglitazone can reduce the risk of death, heart attack, and stroke in high-risk patients with type 2 diabetes, concludes an article in this week's issue of The Lancet. Patients with diabetes have a two to four-fold increased risk of a cardiovascular event compared with non-diabetics. Until now there has only been indirect evidence suggesting that pioglitazone could reduce cardiovascular-related deaths and illness in diabetics."

Neural stem cells are long-lived

"New studies in mice have shown that immature stem cells that proliferate to form brain tissues can function for at least a year -- most of the life span of a mouse -- and give rise to multiple types of neural cells, not just neurons. The discovery may bode well for the use of these neural stem cells to regenerate brain tissue lost to injury or disease. Alexandra L. Joyner, a Howard Hughes Medical Institute investigator at New York University School of Medicine, and her former postdoctoral fellow, Sohyun Ahn, who is now at the National Institute of Child Health and Human Development, published their findings in the October 6, 2005, issue of the journal Nature. They said the technique they used to trace the fate of stem cells could also be used to understand the roles of stem cells in tissue repair and cancer progression."

Genomes of more than 200 human flu strains reveal a dynamic virus

"In the first large-scale effort of its kind, researchers have determined the full genetic sequence of more than 200 distinct strains of human influenza virus. The information, being made available in a publicly accessible database, is expected to help scientists better understand how flu viruses evolve, spread and cause disease. The genomic data already has enabled scientists to determine why the 2003-4 annual influenza vaccine did not fully protect individuals against the flu that season. The new genomes are the initial results of the Influenza Genome Sequencing Project, a joint effort of the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH), and multiple partners including NIH's National Center for Biotechnology Information (NCBI), the Wadsworth Center of the New York State Department of Health in Albany, NY, and The Institute for Genomic Research (TIGR) in Rockville, MD. The report was published online in the journal Nature on October 5."

I would've thought that the several centuries of information that we have on the flu virus would've been enough to show that it was a dynamic virus.

Valete omnes,
Bravo.

And have a safe Friday night.

Update

Howdy everyone,

This week never ends. Everytime I turn around I find that I have a whole new assignment to do.

I ran three calls at the football game last week. Only one was a transport (fight had broken out). Nice laceration to the upper lip and gum.

Medical News/Articles:


Most Americans will become overweight, 90% of men and 70% of women

"According to a study that has just come out, the vast majority of Americans will be fat. Even half of the men in the study who were of normal weight during a good part of their adult life eventually became obese. According to the study, 70% of American women and 90% of American men will eventually get fat. "

Immunization at global level maintains strong performance made in last quarter century

"Immunization at the global level has progressed very well during the past 25 years, but further increases in coverage would save the lives of millions more who do not yet benefit from this protection, said a group of immunization partners at the World Vaccine Congress in Lyon, France."

I'm out.