+1 for organization/structure as foundation of effective communication.
Learners often struggle with shifting expectations. And teachers sometimes associated highly structured presentations with wordy ones. So I want to emphasize:
Example: here is a organized and efficient yet thorough presentation. < 1 minute. < 3 tweets.
“Ms J is our lady with HF and DM here with pyelo.
This morning back pain is better, dysuria’s gone. Didn’t sleep well from noise.
Tmax 99.7, BP around 150s, other VS normal...”
“...Looks more comfy, oriented. JV 10cm, lungs clear. CVA less tender.
White count 10 from 16. Chem 7 totally normal. Sugars were 180, 203, 144, 130. Urine with E.coli, sensies pending.
Right now she’s on ceftriaxone, lisinopril, metop, Lantus + prandial, senna, prn APAP...”
“..So for her Pyelo, seems better by symptoms, fever/white count. Continue CTX, watch culture.
For HF: infection is improving and now BP and JVP rising. I restarted home lasix.
That ok?
Cool.
Sugars are good.
For insomnia I gave her ear plugs and asked RN to skip vitals.”
I know folks have different expectations about granularity of data, style, word choice, etc.
E.g. in some ways, that was longer than it needed to be. You could decide you don’t need the team’s input on managing the diabetes and insomnia today, and not bring them up.
But that’s a different issue.
The point is, it’s hard to go wrong with being organized and communicating with a predictable format/agenda.
Stick with that structure; filter and adjust content within the structure to vary thoroughness vs. conciseness.
6/6
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Op report: “gangrenous cholecystitis with extremely friable tissue. Purulent drainage with manipulation of gallbladder.”
I've seen this many times.
Thread
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Like any test, RUQUS is not perfect in detecting cholecystitis.
A systematic review in 2012 put pooled sensitivity at 81%, but as you see in plot of included studies, there's heterogeneity, with sensitivity as low as 50% in some studies.
Press the hypothenar edge of your hand firmly against your own ribcage. You're gonna keep it there the whole time while you say some stuff and feel the amount of vibrations transmitted.
Let's go.
1/5
Experiment # 1:
Compare the amount of fremitus/vibration when you say:
ninety-nine
noy-noy-noy
one-two-three
Feel free to repeat a couple times.
Did any of them cause more vibration than others?
2/5
Experiment #2
Pick any one of the three chants above.
Compare the amount of vibrations when you say the phrase in the lowest (deepest) voice you can muster... vs. a high-pitched (e.g. falsetto-y) voice.
Can upper GI bleeding cause hyperkalemia in predisposed people?
I feel like I’ve gotten that vibe from a couple patients. I can’t find any reports from others.. but I can think of a mechanism...
1/
Blood contains a lot of protein.
When a significant amount of it is introduced into the proximal GI lumen (and some of it absorbed), it can elevate your BUN, or trigger hepatic encephalopathy.
2/
The concentration of potassium in RBCs is ~100 mMol, meaning 100 mEq/L. If you start at a hematocrit of 40 and bleed 20% of your blood volume into your stomach...
That’s ~1 liter blood = 400 cc of red cells = 40 mEq of potassium.
3/