Do the following things, in this order of priority.
- Dehydration – rehydrate with IV fluids
- Insulin – to combat hyperglycaemia
- Electrolytes – potassium shifts are a concern
A simple acronym solves everything. The point is not to let the patient DIE.
Author: howtowinfriendsandinfluenza
The Sad Evils Of Smoked Salmon
Smoked seafood has, unfortunately, been cast into the same category as preserved meats. These traitors have been linked with an increased risk of malignancy. Shun them all!
On the plus side, chicken is still in season(ing). As long as you’re not a greedy pig about it. Moderation, which basically means not over-gorging, is the key to success. That is, health.
References
- Egan, S. (2019). Do Lox and Other Smoked Fish Increase Cancer Risk?. Retrieved 29 August 2019, from https://www.nytimes.com/2019/07/26/well/eat/does-lox-and-other-smoked-fish-increase-cancer-risk.html
- Meat, Poultry, and Fish: Picking Healthy Proteins. (2017). Retrieved 29 August 2019, from https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/nutrition-basics/meat-poultry-and-fish-picking-healthy-proteins
Podcast 031: Vascular Surgery With Dr Gabrielle McMullin
Blood vessels are needed to keep the liquid of life pumping throughout our bodies. Bad vessels lead to bad flow, which is undoubtedly a bad thing.
In this episode, Dr Gabrielle talks about vascular surgery, rather interesting stories and workplace injustice.
Podcast
About the guest speaker
Dr Gabrielle McMullin is a consultant vascular and endovascular surgeon with a long list of letters adorning her name: MB BCh BAO FRCSEd FRACS MCh. She is a specialist at The Sutherland and St George Hospitals in Sydney, as well as a mentor for women in surgery.
Dr Gabrielle was born in Uganda, attended school in Hong Kong and studied medicine at Trinity College in Dublin. She then worked in numerous countries, including Ireland, New Zealand, Papua New Guinea, Hong Kong, England and Australia, where she has lived for 25 years. It has been a fascinating journey.
Dr Gabrielle spends what is left of her spare time with her husband and 2 children.
Music credits
Opening and closing auditory experiences by Rupert Keller.
Médecins Sans Fashion
The greatest dilemma of any doctor is the colour of stethoscope to acquire. Hue, like the flavour of McDonald’s sundae you select, shows a revealing amount of personality.
For the ultimate assistance with style in the wards, there is Uniqlo. There is also Médecins Sans Fashion.
Podcast 030: Anaesthetics With Dr Marie Dreux
Anaesthetics! And the people who do it! They might have a title that’s hard to pronounce, but the ability to guide patients through operations safely remains rewarding.
In this episode, Dr Marie talks about life as an anaesthseticoshcsdokdtist, interesting cases and training advice.
Podcast
About the guest speaker
Dr Marie-Louise Dreux is an Anaesthetics Senior Staff Specialist at St George Hospital, Sydney. She trained at St Vincent’s Hospital and has worked in Alice Springs, Limerick (Ireland) and Basel (Switzerland), as well as St George.
Dr Marie is a keen violinist, playing in NSW Doctors’ Orchestra, Australian Doctors Orchestra and World Doctors Orchestra, as well as a passionate Sydney Swans supporter and member.
Music credits
Chill beats by Professor Phil Poronnik.
Settling The Contradiction In Urination Theory
Conventional medicine teaches that the parasympathetic system, through its powers on detrusor muscle contraction and internal sphincter relaxation, leads to micturition. Meanwhile, the sympathetic system does the opposite so the bladder does not push that sweet, gold urine out but holds it in.
Why, then, do people urinate more when they are nervous?
The pontine micturition centre is indeed an important area, one that struts around like a pompous turkey with its chest puffed out, wearing a mauve suit and a top hat. It certainly affects the desire to urinate. However, it is tempered by the all-powerful prefrontal cortex. That old dog!
The trusty prefrontal cortex: this fine specimen of modern decision-making prevents you from running yellow liquid down your leg, however surreptitiously you think it might be happening, while making small talk at a cocktail party or waiting in line at the post office. In short, it keeps socially inappropriate things from occurring at socially inappropriate times.
When the brain is racked by fear, the prefrontal cortex shuts down just a little, despite that possibly being the time you need it the most. No matter, because logic is replaced by emotion!
When the inhibition goes, so too does the bladder.
References
- Arnold, J., McLeod, N., Thani-Gasalam, R., & Rashid, P. (2012). Overactive bladder syndrome – management and treatment options. Retrieved from https://www.racgp.org.au/afp/2012/november/overactive-bladder-syndrome/
- Palmer, B. (2011). Can You Be Scared Enough To Pee Your Pants?. Retrieved from https://slate.com/news-and-politics/2011/10/peeing-your-pants-why-do-people-urinate-when-they-re-scared.html
- Innervation of the Lower Urinary Tract. (2018). Retrieved from http://vanat.cvm.umn.edu/lut/Innervation.html
- Know your brain: Prefrontal cortex. (2014). Retrieved from https://neuroscientificallychallenged.com/blog/2014/5/16/know-your-brain-prefrontal-cortex
Positive Psychology 101
Nothing is real unless it exists in the outside world.
Your thoughts are not real. You cannot control them. But you can control the environment that affects them.
You cannot control where a dog urinates during a friendly neighbourhood walk. Will it be on the stump of a tree today? Or will it very coincidentally be under the letterbox of the old man across the street you do not particularly like? You cannot precisely determine this, even knowing it would almost certainly occur at some point during the stroll, but you can create lessons and precedents to influence what is considered more acceptable and what is considered less so.
Your thoughts are a wild farm animal zipping around in a fenced paddock. In a particular instance, the beast runs where it wants. At any given moment, you cannot decide exactly where in that enclosed field the your thoughts are. This level of microscopic precision is out of your control.
However, by maintaining an environment conducive to the kind of thoughts that you would like, you can control the dimensions, the weather and the general disposition of that paddock.
It is okay to be human.
Humans cannot control their exact thoughts but, over time, they are very good at meddling with man-made objects and putting artificial restrictions on things.
This is positive psychology 101: you can influence the world around you in order to become less of a grump.
The Trajectory Of Adult Weight Gain
Behold! It is 500-1000g annually.
If you want to change your future for the better: sleep enough, eat healthy food and don’t be a sloth.
And maybe fidget to burn more energy, so you can eat more food.
Food is great.
References
- Hutfless S, Maruthur NM, Wilson RF, et al. Strategies to Prevent Weight Gain Among Adults [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2013 Mar. (Comparative Effectiveness Reviews, No. 97.) Available from: https://www.ncbi.nlm.nih.gov/books/NBK133218/
- Robards, T. (2016). Is it natural to get fatter with age?. Retrieved from https://www.news.com.au/lifestyle/fitness/weight-loss/is-it-normal-to-get-fatter-with-age-or-is-that-just-an-excuse/news-story/70471ba826cfbf8d125d24b31c77eb50
- Healthy Weight. Retrieved from https://www.hsph.harvard.edu/nutritionsource/healthy-weight/
- Publishing, H. (2015). Does Metabolism Matter in Weight Loss?. Retrieved from https://www.health.harvard.edu/diet-and-weight-loss/does-metabolism-matter-in-weight-loss
Podcast 029: Geriatrics With Dr Chris Middlemiss
Do you like cakes and constructing intricate delicacies in the comfort of your kitchen? No? Well, that’s too bad!
The recipe for geriatrics is diverse and beautiful. It’s 5 parts general medicine, 2 parts falls investigations, 1 part deathly despair, 3 parts woolly sweaters and 5 parts super cool.
In this episode, Dr Chris talks about the many reasons a senior citizen presents to hospital, the balanced geriatrician lifestyle and how to find your ultimate calling.
Podcast
About the guest speaker
Dr Chris Middlemiss is a geriatrician and “nan whisperer”, who took his time working out what he wanted to do. He works at Sutherland Hospital, and also at the Garrawarra Centre, an aged care facility specialising in the care of behavioural and psychological symptoms of dementia.
Chris is married with two kids, and plays soccer adequately when he is wearing his contacts.
Music credits
Opening and closing themes by Professor Phil Poronnik.
The Flushing Of Cannulas
Goose. Geese. Moose. Meese. Cannulas. Cannulae. Whatever!
Blood Extraction
Why throw away the first 10mL of blood when collecting it from an existing cannula? It’s because that portion is theoretically contaminated, such as by previous infusions.
Saline Flush
The purpose is, also theoretically, to keep the cannula open and working. Patent, as they say. That’s why this is recommended after giving IV medications or just periodically. Basically, after each use.
Not Water
Normal saline is injected, not water. This is because a pure water injection would lead to the water rushing into red blood cells, due to that trusty process of osmosis. This sudden water influx would make them explode.
Which, as you can imagine, would run counter to the usual hospital purpose of trying to heal people, not atomically bomb their bloodstream.
References
- Blood collection from intravenous cannula. (2019). Retrieved from https://vitualis.wordpress.com/2006/05/15/blood-collection-from-intravenous-cannula/
- Keogh, S., Flynn, J., Marsh, N., Mihala, G., Davies, K., & Rickard, C. (2016). Varied flushing frequency and volume to prevent peripheral intravenous catheter failure: a pilot, factorial randomised controlled trial in adult medical-surgical hospital patients. Trials, 17(1), 348. doi:10.1186/s13063-016-1470-6
- Labos, C. (2019). Why can I taste saline and medications when they’re inserted into my IV?. Retrieved from https://www.mcgill.ca/oss/article/you-asked/why-can-i-taste-saline-when-its-injected-my-iv
How To Win Friends & Influenza 