acid base irregularities and anion gaps

It's seems no matter how often I go over the acid-base rules, it seems like it's new every time. There are so many times that I think I need to understand these things so I can care for my patients but seem to just go back to basics to make sure that my gut response is correct. It's amazing to me that we are able to learn so much about our patients' health and metabolism based on anions and cations.

Medicine is so cool.

mmmmm, tastes like summer

after 4 weeks of paediatrics I'm ecstatic to have the weekend off. Not just off, but spending it outside listening to live music and enjoying the weather. And becoming mildly intoxicated.

In the paeds ED, in no paticular order I:
sutured 3 fingers, a lip, a head
saw kid vs. lawnmower
saw what emotional shock can do to the parent of kid vs. lawnmower
fish hook in finger
first presentation of brain cancer
set 2 feet and 2 arms
way too many kids with constipation, gastritis or a cold
one over worked mom who just needed a bit of quiet time and reassurance
several cases of cocksackie
possible child abuse vs. anorexia ?vs. crohn's (that's something for inpatient to sort out)
a kid with a cold whose dad was worried the dying mother might get sick if they visited and wanted permission to go see Mom (heart breaking, especially when they were triaged as not important)
well,sick, happy and sad kids

it's been a good two weeks

drives me crazy

so many people come outside emerg and smoke

it's disgusting and makes me literally sick at the end of my shift

being beat up by the pediatric neuroloist in teaching

also known as shame based learning

make it stop

peds emerg has a predictable pattern

If the weather is great, only the sickest come in.

In the morning, it's the kids with colds so bad they couldn't sleep
the night before.

Right after school are some sick kids: those who are puking or overall
just look terrible.

Around 6 or 7 are the kids who have hurt themselves playing sports,
falling off the jungle gym or bike.

At 9 are the kids with wacky genital stuff that their parents saw
while giving the evening bath.

the best part of working in the ED is days off

This morning I'm sitting on my patio with my cats, drinking Starbucks, eating a scone, loving my garden, enjoying the weather and Reading a book for fun.

FOR FUN!!!

I'm reading Complications, A Surgeon's Notes on an Imperfect Science by Atul Gawande. He's a general surgeon out of Boston and unlike the general surgeons I've recently experienced is very thoughtful.

The chapter I'm currently reading is about the need for learners to practice and the ethical implications that what we need to practice on are people. Given the choice between a fellow and a consultant caring for his son, even though Gawande himself was a resident at the time, he chose the consultant.

I know I keep coming back to this problem in medicine, but I really think it's an important one. Learners learn through practice but who wants someone to practice on the one they love?

How will we get to do enough procedures master them and allow the generation before us to retire?

cancer sucks

I wanted so much for the adorable kid in the ED to have another reason for her strange new gait. I looked for sore joints, for infection even for heart murmurs. Even though I knew there was a lesion in her young brain, I really wanted to be wrong.

The CT wouldn't let me.

It's not even a good lesion that is easily fixed, it's a yucky one.

And her father thanked me. I guess knowing what you're up against is somehow reassuring.

miscommunication sucks

I had a poor little kiddo tonight in the ED who was in a lot of pain. He had the misfortune of coming in during shift change for the nurses so his pain meds were lost in the shuffle. There also weren't any TVs left for him to borrow to distract him from the fracture pain.

To keep him comfy I offered him my phone to listen to a Dr. Seuss story that is read outloud. I offered him The Lorax, he asked if I had Cat in the Hat. Which, being the iPhone app junky I am, I had.

I'm turning into an iPhone ad at work.

there's no jobs in medicine (sic)

There are 2 residents in the flop room talking about what they want to do. One is a medicine resident, the other an orthopedic surgery resident. They keep saying that there aren't any jobs. They also keep using words like "retarded" not used in the context of development.

I don't want to say idiot but you know, they're idiots.

summer flu

probably rsv

this is the problem with paeds

sushi is my comfort food

mmmmm

apropos of nothing

I was just thinking about my first boy-girl party.

It was my best friend's 13 birthday, the summer before we went to high school. We were in her dank unfinished basement in the dark with music playing and pop and chips. There was apparently a chair shortage since many of the girls needed to sit on boys' laps. Music was blasting (likely AC/DC or Bon Jovi) and I felt completely out of place. I don't think I've ever known how to behave at parties, let alone ones like this. These weren't really even our friends. If there was a movie theatre in town, I'm sure they would have rather been there, but with the slim pickings they found it worthwhile to be in the dark basement.

It's difficult to decide when it's time to go. Do I feign a curfew? A headache? Do I tell her I'm bored out of my skull because I don't have a lap to sit in?

These are the things I wish they'd taught us in health class instead of how our ovaries worked.

more apps I'm using in clerkship

The Pre-test apps: There are a series of apps from Pre-Test. The same folks who put together the books. I have pdfs of the books as well, but I tended to use these instead. You can set up quizzes of varying lengths depending on how much time (or attention) you have. Each question has a detailed answer that can be too wordy, but can also be very helpful.

If you are writing an NBME these are very helpful. There are questions that only an American would ask, something I wasn't used to and was useful for passing my shelf exams.

I liked having these for "in between" times, waiting for clinic to start, an OR to start or your patient to make it in. But they are NOT cheap.

Available in medicine, psychiatry, emergency medicine, surgery, pediatrics, obs gyne, neurology, family medicine.

P: $29.99

Mnemonics: This resource has been pretty helpful, especially when trying to translate what a resident has said to me :)

It seems to have been put together by residents and medical students. I don't recognise all these study aids, but they are mostly useful. To be honest though, I didn't have that much time to really use them. It may be more helpful next year for the LMCE.

They can be filtered by discipline which can be very helpful. There's also a search function that lets you try to figure out why your surgery resident is talking about "Vindicate".

P: $1.99

Procedure Tracker: I was looking for a quick and organized way to keep track of the little procedures I get to do during clerkship so that I have them ready for my CaRMS tour. This is not the way to do it. It's not terribly user friendly and has very few procedures. To switch between specialties you need to change your settings each time, even thought there should be an incredible amount of overlap between many of them. Like many apps like this, it doesn't give you an option of putting in your own procedure. I get wanting to keep them unified so that you can quickly see what you have and haven't done, but I'd rather be able to add my own to their list.

But it's free.

P: Free

call night is usually spent in the ED

There are mostly snot nosed kids down in emerg. Also teens who are thinking about killing themselves, teens who drank too much and become beligerent, and young teens who may be pregnant.

It's incredibly odd to see the groups of cherubs next to these kooky teens.

the paeds call room: if I'm good I may actually get to take a nap tonight...

Volunteering isn't always what you sign up for

Funny story.

One of my babies on the floor today was crying quite a bit. A
ridiculous amount. There was a little granny volunteer rocking baby,
snuggling her and trying to get her to calm down.

When baby finally settled, granny put her back into the crib with a
pacifier, rubbing her back keeping the pacifier in while baby fussed.
Then granny left.

When granny was half way down the hall, baby started crying again.

Granny almost ran down the hall. I'm sure she was thinking that this
wasn't what she'd signed up to do.