Two years ago. I sat at my desk checking other successful brands in the field of medical education. I was awestruck by how many friends, fans, and followers they had. I felt that this was your way of saying thank you to those who were helping you. At this moment, I thought, I will never be able to do this. This recognition is reserved only for the best.
Then I got to work – as you know, I always do. I wrote down my philosophy. When I die I hope people say, “he worked tirelessly to improve patient care.” I didn’t care if drbeen was small, or we practically had no fans or followers, or that we were a brand not even worth noticing.
Two years later, we’ve just crossed half a million fans and followers this month. I am sitting at my desk, with eyes welling up. Overwhelmed with your love and support.
I have no words to say you thank you, jump into my melting heart, feel it and know that it is my thanks to you. 💕🌹
Thank you for your love and support. We will continue to offer our services and make them even better because you are worth it. Because YOU ARE IMPORTANT to us. Because we are nothing without you. Thank you again. 💕💕💕
64 y F with Hx of emphysema, HTN, laparoscopic hemicolectomy for Stage 2 colorectal cancer, and femoral hernia who presents with cramping abdominal pain, nausea, and vomiting. Her last bowel movement was yesterday morning. On exam, she has a distended abdomen with mild diffuse tenderness without rebound or guarding. She has a lump in her left groin which is reducible and non-tender.
Vitals: T 37.2C, HR 98, BP 138/74, SpO2 93%.
Her WBC is 10.1, Hb 11.4, BUN 39, Cr 1.1, LFTs normal. CT Abdomen / Pelvis shows dilated loops of small bowel with a transition point.
What is the appropriate management?
Impella is a ventricular assist device, that is FDA approved for short-term support of the left ventricle. There is also a version that can be used for the right ventricle as well. The device can support 2.5 to 5 L/min of blood flow, the latter of which is considered a normal cardiac output.
Studies show that the high level of stress endured by medical students may actually hinder one’s cognitive function and learning ability. Not to mention, research reveals that 27 percent of all medical students are depressed, with 11 percent having suicidal thoughts. If the stress and depression are not managed early on, it’s likely that it will carry on into their professional careers, which can potentially lead to early burnout. No matter how many research papers you have to write or exams to study for, the number one thing on your list should be taking care of your mental health so you don’t start exhibiting self-destructive behavior.
Avoid Falling Into a Substance Abuse Trap
Between the pressures of studies and a pile of debt from tuition, it’s not uncommon for a medical student to turn to drugs and alcohol as a coping method. Nearly a third of students report alcohol abuse, with burnout and exhaustion being the main driving factors. There’s also a correlation between the type of abuse with the field of study. For example, resident surgeons tend to abuse alcohol, while those in emergency medicine also abuse benzodiazepines, cocaine, and marijuana. While the following mental health tips can help prevent an addiction, should you find yourself hooked on a substance, it’s a good idea to get treated at a facility that specifically caters to medical professionals—even if you’re still a student. Aside from the obvious reasons, it’s important to immediately address your addiction. If it continues into your professional practice, you run the risk of having your license revoked.
Take Regular Breathers
The heart pumps a volume of blood into the lungs which after getting oxygenated is transported back to heart. This oxygenated blood is then pumped out of the heart and into the aorta and subsequently into the systemic circulation. As a consequence, at any given time the lungs (pulmonary vasculature) contain around 500ml of blood, thereby allowing them to function as a reservoir of the blood. This reservoir volume is increased by 500 ml when the person is in the supine or lying down position. This is because in supine position there’s an increased venous return (due to the effect of gravity) to the right heart from the peripheries and therefore more blood accumulates in the central parts of body. Upon standing up, this extra 500ml of blood gets redistributed under the effect of gravity, to the now more dependent parts of the body which includes the peripheral tissues and the lower extremities.
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The division of vasculature in the pulmonary circuit is somewhat different from that in the systemic circulation. The arteries in the pulmonary circuit divide in a binary fashion, thereby following the pattern of division of the airways. The veins too exhibit a pattern similar to the arterioles and the bronchioles, thereby finally converging into forming one large pulmonary vein. These pulmonary veins transport the oxygenated blood back to the heart.
NODAL ACTION POTENTIAL VS. VENTRICULAR ACTION POTENTIAL
The nodal tissues and the Purkinje fibers exhibit automaticity in their properties as they are able to undergo spontaneous depolarizations. In other words, these tissues do not require the need of an external stimulus or a trigger to undergo depolarization. This is in contrast to ventricular fibers that do not show automaticity. The reason behind this phenomenon can be explained as follow:
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- The resting membrane potential (RMP) of nodal tissues is less negative than the RMP of ventricular fibers. This allows the nodal tissue channels to operate in a semi-activated state even during the resting phase of the action potential. The comparatively more negative ventricular fibers do not show this property and hence, are not easily activated by low voltage impulses.