Easy ECG

Even in the advent of modern diagnostic machines in the world of medicine, ECG or EKG remains the fastest and simplest way to look into the heart. It is still very useful especially in the Clinical or Emergency Room settings where a quick determination of the heart’s function is paramount especially in cases of Acute Myocardial Infarction or Heart Attack.

The Electrocardiogram can determine a heart block, enlarged heart muscles and rhythm disturbances. It also helps determine previous cases of heart attack. Thus, the ECG is a valuable tool because it helps diagnose irregularities and changes in the heart as well as to establish a baseline for subsequent ECGs.

Here are some videos that will help you further understand the concept and importance of the Electrocardiogram--








video credits:

Dr. Dean Keller and Dr. Melissa Stiles
University of Wisconsin School of Medicine and Public Health

Assessing Lung Sounds

Normal Breath Sounds
The correct sequence of auscultation of the posterior chest is shown in the picture below. The sequence is from the apex to the base of the lungs from one side to the other including the lateral areas of the lungs.

Credits: Dr. Pat O'Leary
David W. Woodruff, MSN, RN- BC, CNS, CEN

Gastric bypass anatomy leads to diabetes control

The Reuters article below which is about the relationship between gastric bypass and diabetes control further reinforce the phenomenon that many physicians are now encountering in their practice.

I have seen a lot of people who has diabetes and high levels of blood glucose but are now symptom- free after undergoing a gastric bypass. Now, this article will further explain the mechanism behind this new phenomenon.

So, read on…

NEW YORK (Reuters Health) - The rapid and substantial control of diabetes seen after gastric bypass surgery is due, at least in part, to the intestinal rearrangement involved in the procedure, the results of an animal study suggest.

Besides removing a substantial portion of the stomach, gastric bypass also attaches the output of the stomach to the lower intestines. The lower portion of the gut usually produces little glucose, but because of the direct input from the stomach it increases its production, French researchers report in the research journal Cell Metabolism.

The liver senses the higher level of glucose and reduces its own production of the sugar. Since the liver contributes much more to the body's overall glucose production than do the intestines, the net effect is enhanced glucose control, say Dr. Gilles Mithieux, from Universite de Lyon, and colleagues.

The increase in intestinal glucose formation was only noted with gastric bypass, not with gastric banding, which doesn't re-route the intestines. This may explain why only gastric bypass has been associated with enhanced diabetes control, the investigators conclude.

Furthermore, they note, sensors in the liver detect the elevated glucose and send an appetite-suppressing signal to the brain, which contributes to the satiety and weight loss seen with gastric bypass.

SOURCE: Cell Metabolism, September 3, 2008.

Urethral Catheterization

Urethral catheterization is a frequently performed bed side procedure; if done haphazardly it may lead to infection, particularly if the catheter is left for long periods.

Urethral catheterization is done usually with a balloon tip Foley Catheter of varying sizes (8 Fr* to 26 Fr). The balloon size for most of the applications is designed to hold little over 5 ccs of fluid. Larger Foley catheters with balloon capacity in excess of 30 ccs are available for specific urology purposes. For an average adult sizes 14 to 18 Fr catheters are usually utilized.

Indications for urethral catheterization:
1. Urinary retention (palpable, prominent urinary bladder)
2. To keep the patient dry and manageable when he is obtended or comatose
3. Management of incontinence of urine
4. To watch hourly urine output in intensive care situation.
5. As a part of urologic studies and also managing post operative status.
6. To obtain a catheterized specimen of urine for culture and sensitivity when specially required. (Spontaneously voided midstream specimen is good enough under majority of circumstances and it is rarely necessary to catheterize for diagnosis of UTI).

NOTE: Where there is obvious injury to urethra following trauma Foley catheterization should not be attempted before cystourethrogram is performed.

Procedure:

Although the procedure may vary minimally between male and female patients, the basic principles of aseptic precautions and positioning are essentially the same.
Preliminary hand wash and wearing of cap and mask recommended.

Patient should be in the supine position with legs slightly apart for the male and with legs apart and knees flexed for the female patient.

A preliminary soap and water wash to the external genitalia is desirable.
From this point all procedures are done with sterile gloves.

External preparation of genitalia is performed using betadine pain and sterile drapes are laid to provide adequate exposure to the external genitalia.

Appropriate catheter is picked up and the integrity of the balloon is checked by introducing 5 cc of water into the balloon and deflated.

The sterile catheter is lubricated adequately with sterile jelly lubricant.

Catheterization of the male patient:

The penis is held with the left hand away from the scrotum and holding the catheter firmly with the right hand the well lubricated catheter is gently passed through the external urethral meatus. This is gently and gradually advanced and under most circumstances it is passed through the urinary sphincter without any problem.

Occasionally some resistance may be encountered at the level of the sphincter due to prostatic hypertrophy. By gently advancing further through the sphincter this can be overcome to some extent and catheter can be passed into the bladder.

Occasionally a larger catheter or a “coude” type of catheter may be required to overcome this obstruction. When the catheter passes into the bladder, urine will be seen coming through the catheter. At this point, it is advanced by another 1 to 2 cms and the balloon is inflated with 5 cc or sterile water.

The Foley catheter after collecting specimens for urinalysis and culture is then connected to the Foley bag. Some physicians prefer to apply betadine ointment at the external urethral orifice. The Foley catheter may be stabilized to the medial aspect of one of the thighs using adhesive tapes. This prevents the Foley catheter advancing more towards the bladder thereby carrying infection and also prevents it from unnecessary movements causing discomforts.

Catheterization of the female patient:

In the female, the vulval outlet and labia are carefully washed and painted with betadine and appropriate sterile drapes are laid. With the left hand exposing the urethral meatus by separating the labia with the thumb and index fingers the external urethral meatus is identified and previously lubricated catheter is carefully and gently advanced through it into the bladder.

Care should be taken not to contaminate the catheter by touching the unprepared parts of the genitalia and the vagina. Once the catheter is well placed inside the bladder and the urine is seen coming out of the tube the balloon is distended with 5 cc of sterile water and catheter connected and fixed as described earlier.


Post Catheterization management has to be carefully planned to avoid infections. Except in selected patients, routine antibiotic administration is not necessary. Catheter care and change of catheters when necessary should be remembered. In a hospital set up, catheter induced nosocomial infections of the urinary tract are fairly common. When prolonged catheterization is required appropriate urological and where necessary neurological consultations are obtained to plan long term management of the catheter dependent patient. Ambulatory patients who have Foley catheters left in situ are given appropriate instructions and training in the care of the catheters and also plan periodical visits to the doctors and health care staff.

Note: Consider – use of silicon coated catheter for long-term placements

Credits: NurseReview.Org/ Medindia.net

Face Value

Face transplant patient can smile, blink again



By MARIA CHENG, AP Medical Writer
Fri Aug 22, 7:37 AM ET

LONDON - Transplanting faces may seem like science fiction, but doctors say the experimental surgeries could one day become routine. Two of the world's three teams that have done partial face transplants reported Friday that their techniques were surprisingly effective, though complications exist and more work is still needed.

"There is no reason to think these face transplants would not be as common as kidney or liver transplants one day," said Dr. Laurent Lantieri, one of the French doctors who operated on a man severely disfigured by a genetic disease.

In Friday's issue of the British medical journal Lancet, Lantieri and colleagues reported on their patient's status one year after the transplant. Chinese doctors also reported on their patient, two years after his surgery.

Last year, the French team operated on a 29-year-old man with tumors that blurred his features in a face that looked almost monstrous. They transplanted a new lower face from a donor, giving the patient new cheeks, a nose and mouth. Six months later, he could smile and blink.

The Chinese patient had part of his face ripped off by a bear. Surgeons in Xian gave him a new nose, upper lip and cheek from a donor. After a few months, he could eat, drink and talk normally, and returned home to Yunnan province in southwest China.

The patients were not identified although photos were included in the reports.

As is the case with all transplants, doctors use immune-suppressing drugs to prevent the recipient's body from attacking the donated tissue. In both face transplants, the patients started rejecting the transplanted tissue more than once. Their doctors solved the problem by juggling their medications.

The French patient now takes three pills a day to prevent rejection.

"That's less than most people with diabetes," said Lantieri, a plastic surgeon at the Henri Mondor-Albert Chenevier Hospital in suburban Paris.

Other doctors were reassured by the results.

"To be able to wean down the dosage of the medication in small amounts and relatively quickly, that is encouraging," said Dr. Bohdan Pomahac, a plastic surgeon at the Brigham and Women's Hospital in Boston.

Pomahac has permission to do a face transplant in the U.S., as do doctors at the Cleveland Clinic.

Experts have worried that if patients take lifelong anti-rejection drugs after a transplant, their cancer risk will jump. Some also predicted that rejection would destroy the face within a few years. Those fears seem to have been allayed, Pomahac said.

With three successful partial face transplants so far — including the world's first on a woman whose face was bitten off by a dog in France — doctors say that some of the surgery's initial uncertainties, like how functional the new face would be, are being answered.

For example, Lantieri's patient's face was paralyzed by tumors for more than a decade. The French team wasn't sure if nerves could grow after the transplant. But they discovered later their patient could blink, proving the brain was able to restore long-forgotten facial nerve connections.

Not everyone is convinced that face transplants are so revolutionary.

Dr. Patrick Warnke, a plastic surgeon at the University of Kiel in Germany, calls them a "dead-end road," because he doesn't think the rejection problem can be solved. Instead, he hopes to re-grow tissue from patients' own stem cells.

Still, the biggest obstacle to more face transplants may not be scientific, but social.

"When kidney transplants first began, people were reluctant to donate because there were a lot of cultural, social and religious issues," Pomahac said. "This is exactly the same scenario now."

Doctors plan to do more face transplants, but are having a hard time finding donors.

"Everyone says they would accept a face transplant if they were disfigured," Lantieri said. "The real question is, would you be a donor, or would you allow your family member to donate their face? That is the answer we need to change."

___

On the Net:

http://www.lancet.com

Philippine Physician Examination Results

TOP TEN PHYSICIANS Board Examinees

1. Marlon Diaz Garcia, Far Eastern University-Nicanor Reyes Medical Foundation -- 88.75%

2. Dave Anthony Pasetes Diomampo, Saint Louis University -- 88.17%

3. Gentry George Teng King, University of Santo Tomas -- 87.42%
Janice Jill Keng Lao, University of the Philippines-Manila -- 87.42%

4. Nemencio Jr Reyes Ronquillo, University of the Philippines-Manila -- 87.17%
Paolo Potato Villanueva, University of Santo Tomas -- 87.17%

5. Allan Louie Espino Cruz, University of Santo Tomas -- 86.92%

6. Philip Blanco Antiporta, University of Santo Tomas -- 86.58%

7. Ma Cristina Dela Cruz Briones, University of Santo Tomas -- 86.42%

8. Lemuel Benedict Robleza Non, University of the Philippines- Manila -- 86.17%
Sheila Jane Tan Zanoria, Cebu Institute of Medicine -- 86.17%

9. Angela Sacayan Apostol, University of the East Ramon Magsaysay Mem. Medical Ctr.-- 86.08%
Karel Ann Alipasa Espejo, University of the Philippines- Manila -- 86.08%

10. Grace Ann Mariano Nicolas, University of Santo Tomas -- 86.00%






Lists of New Physicians--

Dr. A

Dr. B

Dr. C

Dr. D

Dr. E

Dr. F

Dr. G

Dr. H

Dr. I

Dr. J

Dr. K

Dr. L

Dr. M

Dr. N

Dr. O

Dr. P

Dr. Q

Dr. R

Dr. S

Dr. T

Dr. U

Dr. V

Dr. W

Dr. Y

Dr. Z

The Nurse Notes: Old & New

A new nurse throws up when the patient does. An experienced nurse calls housekeeping when the patient throws up.

A new nurse wears so many pins on their name badge you can't read it. An experienced doesn't wear a name badge for liability reasons.

A new nurse charts too much. An experienced nurse doesn't chart enough.

A new nurse loves to run codes. An experienced nurse makes graduate nurses run to codes.

A new nurse wants everyone to know they are a nurse. An experienced nurse doesn't want anyone to know they are a nurse.

A new nurse keeps details and notes on a notepad. An experienced nurse writes on the back of their hands, paper scraps, napkins, etc.

A new nurse will spend all day trying to re-orient a paient. An experienced nurse will chart the patient is dis-orientated and restrain them.

A new nurse can hear any alarm at 50 yards. An experienced nurse can't hear any alarms at any distance.

A new nurse loves to hear abnormal heart and breath sounds. An experienced nurse doesn't even want to hear about them unless the pt is symptomatic.

A new nurse spends 2 hours giving a patient a bath. An experienced nurse lets the nurse's aide give the patient a bath.

A new nurse thinks people respect nurses. An experienced nurse knows everybody blames everything on the nurse.

A new nurse looks for blood on a bandage hoping they will get to change it. An experienced nurse knows a little blood never hurt anybody.

A new nurse looks for a chance "to work with the family". An experienced nurse AVOIDS the family.

A new nurse expects medications and supplies to be delivered on time. An experienced nurse expects them to be never delivered at all.

A new nurse will spend days bladder training an incontinent patient. An experienced nurse will insert a Foley catheter.

A new nurse always answer their phone. An experienced nurse checks their caller ID before answering their phone.

A new nurse thinks psychiatric patients are interesting. An experienced nurse thinks psychiatric patients are crazy.

A new nurse carries reference books in their bag. An experienced nurse carries magazines, lunch and something else in their bag.

A new nurse doesn't find this funny. An experienced nurse does.......


So, what are you?