stsdoc

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

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.

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.

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.

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.

Age? AlcohoL? jaundice? Tylenol? Could be lots of things. First thing I think of is acute hepatitis

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.

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.

Thanks for the resources!:)

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

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:

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.

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.

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.

Come on, Larry, you're grasping at straws Breast Cancer is a Worldwide Epidemic September, 1997 Canada: About 20,000 Canadian women will get breast cancer in 1997, and 5,000 will die of it--a rate nearly identical to that of the neighboring USA, which has 10 times as many people. The Canadian Cancer Society estimates that 99,000 potential years of life were lost to breast cancer in Canada in 1994. USA: One in eight women in the USA will develop breast cancer in her lifetime. The US has one of the highest incidence rates in the world. New cases increased 52% from 1950-1990, with a 4% rise every year from 1982-1987. In 1997, 180,200 cases are expected with an estimated 44,190 deaths. Breast cancer is the leading cause of cancer death for women aged 15-54 and the second for women 55-74. It accounts for 39% of all cancers diagnosed in women. In 1991, the death rate for black women was 19% higher than for white women. UK: In the United Kingdom, one in 12 women will develop breast cancer in her lifetime. There were 34,500 new cases in 1991. In 1994, 14,080 women died of breast cancer--that is 270 deaths a week. The UK has the highest breast cancer mortality rates in the world. Doesn't look like those preventative steps afforded by national health care have done much good in Canada or the UK. Face it, the US has the best system in the world.

carotid bypass blockage of the carotid arteries in the neck can reduce the blood flow to the brain and can therefore cause stroke. the preferred treatment for carotid stenosis (blockage) is a procedure to clean out the artery (endarterectomy). in a small percentage of patients, the artery is so diseased that it cannot be cleaned out. such patients can usually be treated with a carotid bypass operation in which the diseased artery is either bypassed or replaced with a new vessel made of the patient's own vein, or of special plastics. back

BTW, do you ever eat tuna or ANY other salt water fish? You probably get more mercury in that than you do from the flu vaccine.

Gee,that looked like a really unbiased site. The levels of mercury are so minute that it is almost impossible to have adverse effects from them. The bottom line is that clinical research (which, like it or not, is what medicine is based on) has shown flu vaccines to be very effective in preventing and lessening the severity of the flu. I hope you don't force your uneducated views on your patients.

Don't you know how the immune system works? Have you ever taken immuno? Primary exposure to antigen (ie the flu vaccine) "primes" the immune system and creates proliferation of a memory lymphocytes that cause a stronger and faster attack when you come in contact with the real flu virus. I'd like to see the database you're talking about. For a healthcare professional, you sure don't put much faith in medicine.

Albumin increases the capillary oncotic pressure, which sucks fluid from the tissues into the blood. The fluid is filtered through the kidney and peed out.

It doesn't sound like any of you know the rules. When a person is incapable of making decisions for themselves (ie, in Alzheimer's), their power of attorney's wishes are taken just like they were the patient's, as long as they are fully aware of the consequences, understand what they are doing, etc. Failure to follow their orders can result in malpractice which sucks for everyone. The only thing that can be done is to counsel the patients family and hope they make the right decision. You can't forcibly treat anyone. It doesn't seem right, but that's the way things are.

I am just a 2nd year med student, but in a lecture on Geriatrics, we learned that it is a common misconception that older people are not as sexually active as younger people. This results in less questioning and advising on sexual issues by physicians and nurses, and STD's are becoming much more common in elderly populations. I don't know if this is what you had in mind, but I think it's sort of interesting.

I think it's awesome for anyone to try to achieve their lifelong dreams, no matter what age they are. It definitely can be done. In my class (2007), we have several people who are over 30. We have at least two 35 year olds, one 42 year old, and one 52 year old. They are all doing fine as far as I know. Good luck to you!:)

If you know what units you shoud end up with, just make sure everything else cancels out, leaving the correct units. Example: Convert 100lbs to kg If 1 kg = 2.2 lbs: (100 lbs X 1 kg)/2.2 lbs = (100 lbs X kg)/2.2lbs = 45.5 kg (lbs cancel out)

The figure I gave was a very conservative one, and was income after expenses (ie overhead and malpractice). There are many sites out there that list physician salaries based on specialty and geographical area. And no, i don't think I am out of my mind for wanting to better myself through education. I want to know as much as I possibly can about the human body and disease in order to more effectively treat my patients. On the years wasted in school comment, I am what you would call a traditional student (started college right out of high school, med school right out of college). I just finished my first year of med school and I will be 23 on June 12. That makes 26 just out of med school, when I'll make $35-40K a year, and 29-30 just out of residency, when I'll start making 125-200K a year. If I live to be 75 (God willing) I'll have 30-35 years of good practice years, followed by 10-15 good retirement years. The years don't seem like that much when you truly love what you are doing (as I do). That being I said, I can definitely understand having doubts about going to med school later in life. There is a lot more to consider, for sure.