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stsdoc

stsdoc

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  1. Please allow me to explain. The pt you are taking care of suffers from orthostatic hypOtension, ie a severe drop in blood pressure upon standing, which is no doubt what caused the syncope/fall which caused the pt to be admitted in the first place. Now this can be caused by any number of things: medications, autonomic insufficiency d/t diabetes/stroke, adrenal insufficiency, but the common factor is decreased intravascular volume (ie low bp). The treatment of choice for this condition is florinef, which increases blood pressure by acting like aldosterone, a hormone made by the adrenals which increases the reabsorption of sodium by the kidneys, thus raising intravascular volume. This is often used in combination with a high sodium diet to treat this condition. The physician acted appropriately in telling you to reduce the dose of florinef, as this (and this alone) is probably what caused the spike in bp in this patient with orthostatic hypOtension. He also acted appropriately in not ordering any meds which would acutely lower the blood pressure, as this would just again increase the chances of another orthostatic episode/fall. If the pt was not symptomatic from the HTN with headache, visual changes, etc, then continued monitoring of bp is all the treatment needed. The bp should come down with decreased florinef. Sorry for the long post, but I just wanted to show that there is a method to our madness
  2. stsdoc

    Inappropriate ER doc?

    That's the only (legitimate) reason I can think of to ask that question, as this is taught in medical school. Are you foreign/ethnic in any way? If not, than he was either joking or is a complete weirdo.
  3. stsdoc

    OB brings med student without permission

    Patients do have a choice. They make it when they choose to go to a teaching hospital. Of course, if a patient asked me to leave, I gladly would oblige, but this is definitely not common practice.
  4. stsdoc

    OB brings med student without permission

    I definitely agree that medical students should be introduced as students, or introduce themselves as students. I think this is happening more and more, but then again, I was introduced as Dr. XXXX a few months ago while observing a procedure. It made me feel a little uncomfortable, because that makes people think I know more than I do. I don't think med students need permission to learn however, especially at teaching hospitals, where patients are made aware beforehand. It's not like we are just bums off the street. At my school, we all receive HIPAA training and are well supervised. Also, we are easily identified as students by our short white coats and ID badges. Any unprofessionalism/confidentiality violations would result in SEVERE consequences.
  5. stsdoc

    what are we coming to?

    Who develops most new groundbreaking treatments, procedures, technology, drugs, etc, etc. Canada, Italy? I don't think so. If you take the competition out of medicine, then its quality will decline. The reason that we have the best specialists is because they are paid handsomely, which, like it or not, helps attract the best minds into medicine. If you take away that incentive, the quality of medical school applicants will go way down. When there is no incentive to find a better way to so something (ie $$), then how many people do you think will be working their tails off to come up with these new treatments? This is the essence of the capitalistic society, Which makes the U.S. a GREAT place. All other countries feed off of our medical knowledge, our procedures, and our drugs. JMHO. We have some access issues, but as it's been said before, I've never seen anyone, no matter how poor, turned away from the hospital. What needs to be reformed is the INSURANCE industry. I have absolutely NO love for these folks.
  6. stsdoc

    Elevated ALT and AST

    How long has he had the symptoms? Any nausea/vomiting/diarrhea? You said his dad has terminal liver cancer. Does he also have hepatitis? Does your husband help take care of him in any way? What kind of work does he do? Any exposure to chemicals? Is he taking any medications or herbals? Has he eaten any bad seafood lately or done any travelling? Terri's right, it really could be anything, especially since they didn't tell you how elevated the values were.
  7. stsdoc

    Elevated ALT and AST

    Age? AlcohoL? jaundice? Tylenol? Could be lots of things. First thing I think of is acute hepatitis
  8. I would probably advise against it, for a couple of reasons. 1. It is completely unnecessary. The patient contact would come in handy, but you will learn all new ways of doing things and thinking about things in medical school. In fact, medical schools often prefer a "clean slate." 2. By using nursing school as a "stepping stone," you are taking a spot away from someone who truly wants to be a nurse, thus contributing to the nursing shortage. 3. It will be HARD!!! Nursing school or medical school by themselves are tough. I can't imagine doing both! IMO, if you have always wanted to be a physician (which is what it sounds like), then take the prereqs and apply to medical school. I think that most nurses who end up going to medical school don't start out wanting to be physicians, but once they graduate and work in nursing for awhile, they just find out it isn't for them. However, if you have a GENUINE interest in nursing, by all means, go to nursing school with the idea that medical school is a possibility if things don't work out.
  9. stsdoc

    Another question about mid wives

    Very interesting stuff. My wife had expressed some interest in home-birth (when we get to that point:chuckle) after watching numerous shows about it on Discovery Health. From what you guys have posted, it seems like a safe option for uncomplicated pregnancies and that a good amount of screening takes place. Thanks again everyone.
  10. stsdoc

    Another question about mid wives

    Thanks for the resources!:)
  11. stsdoc

    Another question about mid wives

    I was reading the other thread about midwives, and didn't want to hijack the thread with my questions. I was wondering what the liability situation is for midwives and home birthing. I know that many of the precautionary (defensive medicine) measures in hospital births are due to fear of lawsuits, and I also know that avoiding these practices is the goal of many women who choose to do home-birthing. Do midwives carry insurance, or is their some sort of contract with the mother not to sue? Also, I was wondering what the requirements are for being a home-birth candidate (i.e. pregnancy hx, general health, etc.), as well as what type of fetal monitoring is done prenatally (ultrasound, prenatal checkups, etc). I hope my questions aren't too dumb, but I don't know a whole lot about midwifery and I was just curious. Thanks
  12. stsdoc

    Nurses and smoking......

    I just wanted to point out a minor discrepancy in your post. Addiction most definitely does have a genetic component. Studies done on the offspring of alcoholics showed that they had increased chances of becoming alcoholics themselves, even if they were taken away from the alcoholic parents and raised in a non-alcoholic household. Studies have also shown that those with certain genetic makeups are predisposed to nicotine, heroine, and cocaine addiction. So, in regards to factors leading to nicotine addiction and obesity, they are multifactorial, with genetic and environmental components.:balloons:
  13. stsdoc

    Would you tell a family to sue??

    Also, if this "mystery" nurse or someone else who was there doesn't publicly come forward, there is absolutely no way to prove that the sutured artery ever happened at all. Something just doesn't seem right about that story.
  14. stsdoc

    Wit (The Movie)---Insights!

    Funny you should mention that because we watched that film in class last year (in medical school). Very good film. Made me all misty-eyed.
  15. stsdoc

    tympanic membrane of an infant

    The normal tympanic membrane should appear pearly gray, and you should not be able to see blood vessels except on the outer margins. When you can see blood vessels (other than on the margins), this is referred to as "injected."
  16. stsdoc

    another eager student c questions

    I disagree with the idea that those with high grades in coursework will do poorly in clinical work. From my very limited experience, this is just a way for those who have bad grades in the preclinical years to stay motivated to complete the program. Often, those that make bad grades also do poorly in clinicals because they didn't learn the material. Those with high grades that do poorly in clinicals usually do so because of inherent personality flaws (don't work well with others, poor bedside manner, etc.) The one consistent instance in which those with lower grades have an advantage in the clinical years is if they worked in some clinical role before school and have valuable experience that others may not. Also, I would have to say that a 4.0 is definitely NOT looked down upon, but it cannot be solely relied upon to ensure admission. GPA is not the only thing that adcoms look at. I know of several people with high GPA's who were denied admission based on bad interviews, etc.