Sickening

READ THIS!

When I first read this I couldnt believe it. I know there are a great number of chav's, football hooligans and various other bottom feeders out there but this is just insanely low. I want to put emphasis on the fact that SECONDS in emergency care can make a difference.

Admittedly this is from the daily mail, but I have substantiated it via other means.

Its Just Sick

Right Place

I have no problem with religion....well no problem that I can apply to this post. People can believe what they want, when they want as long as they keep it away from me. Faith, Religion and God even have a place in modern medicine, that place is in the waiting room.

There are more than a few people on my course (a very science heavy course) who are creationists, and believe that the universe was created 5000 years ago and the fossils are just a test of faith. There are other inappropriate beliefs going around the nursing and medical degrees at my university. At the end of the day this really scares me. If I have a patient under my care I use my knowledge of science, my understanding of the human body and my faith in my own abilities to treat them. Anyone who does the same is fine in my books, if they want to talk to their god(s) about it once they have dealt with the patient that is also fine. At some point there is going to be a scientologist applying for a medical or nursing degree, as this is a minority faith any university would be obliged to accept them. For those of you who arent familiar with this faith there are a number of ideas that I have no right to take exception to, what I do take exception to is the fact that they dont recognise a number of very common conditions. As far as they are concerned for example Autism isnt a real condition.

There is a time and a place for Religion, that place is not in the operating theatre or the ward, that place is the waiting room, or at home. If you are practising as a healthcare professional you are a scientist, to be anything else is negligent.

Catch 22

A patients blood pressure dropping can indicate nearly anything, couple this with raising tachycardia(Increased Pulse Rate) and pyrexia(Raised Temperature) and you probably have a patient suffering sepsis. Until the antibiotics sort out the sepsis(assuming a surgical pathway hasnt been taken) you have to deal with the patients blood pressure. it needs to be raised to a point where the whole body is receiving enough blood regularly. The popular method of doing this is hanging saline regularly as well as another IV fluid called gellofusin. The idea is that at least you are keeping the circulating volume up even if the actual contents is a little diluted when it comes to oxygen bearing red blood cells.

A common result of cardiac incidents, or general poor cardiac function is the collection of fluid in the preferies(Oedema), and usually this fluid makes its way onto the lungs. This is pretty easily resolved with a nice little diuretic we use called Furosemide. This causes any excess fluid in the body to be passed through the kidneys, into the bladder and given the condition of most of my patients straight into their cathater bag.

So what the hell do you do when you have a patient who has a plumeting blood pressure and is overloaded to the point where their lungs are severely comprimised?

The doctors caring for this patient decided to try and maintain a balancing act, putting enough fluid in to keep her blood pressure compatible with life whilst putting enough furosemide in to stop her drowning. Not an easy thing to do and I dont envy them.

IPLU

So tomorrow is the last day of my InterProfessional Learning Unit for this year. Myself and a group of medical students, ot students, pharmacy students and other nursing students have been auditing some bits and bobs on a neonatal unit. Its been fun but I really miss being a real student nurse so I'm glad this is nearly over.

One thing I haev learned from this unit is that neonatal care scares the hell out of me. I'm an adult branch nursing student. Adults and big, smelly and in general foolish. They are far less fragile than neonates(usually). In general if a neonate is sick enough to be admitted to a ward they are probably balancing on a knife edge. Adults get admitted for everything from a social sort out to the sniffles.

I also have a hard time connecting with paedeatrics and neonatal nurses. In my experiences adult nurses bond with the use of dark humour and grim satire. Paeds nurses are all happy and bubbly. Its probably hard to apply dark humour to critically ill babies.

After tomorrow I get to spend a few days in the lake district. to relax, recoup and drink heavily. Then i'm back and spending a few months in my local A&E department. I am really looking forward to this however I suspect my only duties are going to be taking obs. I cant imagine there is a lot in A&E students are allowed to do.

Two Patients

Patient One

• 18 Year Old Male.
• No Medical History, Normally very healthy.
• Very fit and active.
• Presented to A&E with acute abdominal pain.
• Diagnosed with appendicitis with immediate risk put on the next mornings surgical list.
• Patients family are hypochondriacs and overly dramatic panic mongers.
• Patient goes into theatres for a perfectly routine procedure.

Patient Two

• 87 Year Old Male.
• Repeated relapses of cancer over the last 20 years.
• Chronic Obstructive Pulmonary Disease.
• Not very active and in pretty rough shape at the best of times.
• Patient admitted with increasing Shortness of breath due to infection.
• Infection not responding to antibiotics.
• Deterioration indicates that patient meets the criteria for the liverpool care pathway(will be dead within 72 hours).
• Very upbeat, has had a hard life and accepts everything that is happening.
  

I have treated patients similar to both of these although neither of these patients is exactly like any one patient I have treated. Now heres the challenge for any of you poor readers, Tell me what I will find if I go back in three weeks to see these patients. And tell me why I will find what I do.

Sleep

Its 0425.
Every muscle in my body is aching.
I can barely find the energy to sit up in my chair.
My mind has slipped into an energy sparing melancholia.
I should be fast asleep.

But I'm not. I've spent the last five hours staring at my bedroom ceiling, unable to sleep despite the new depths of fatigue I am currently exploring. I've been back in lectures for a while. Thus the lack of posts, I havent had anything of worth to blog about. Given how exhausted I've been when on placement I decided to take some time off working as a bank carer as well. Finally get some time to just be a student. Unfortunately this is how my body always reacts when I go a prolonged period without work. The lecturers arent challenging(for anyone) at the moment, and despite the fact I am still being very active for some reason I just cant seem to function unless I am working myself to the point of sickness.

In the past I have tried everything through medications, herbal remedies and alcohol (not at the same time) to correct this purpose-deprived insomnia but nothing touches it. So I thought I would throw it out to all you guys, what wierd and wonderful tactics/potions/tricks do you guys use to treat insomnia. Anyone who comes up with something that actually works will earn my undying gratitude.

Mythology: Vampires

Most cultures have superstitions involving beings more or less similar to what we call vampires. In this post I intend to offer a possible medical explanation for these creatures. A condition known as Porferia is caused by a malformation of an enzyme in haem. Haem is a crucial element in our blood and allows our red blood cells to bind to oxygen. The condition can easily be fatal without a treatment, a suppliment of artifical haem. Lets break down the "signs" of vampirism.

Drinking Blood
The folklore states that vampires need to drink blood in order to survive. This is technically a solution for porferia suffers, Ingesting large amounts of human blood would provide the required elements to suppliment low haem levels. However most of the ingested blood would be immediately broken down and unusable in the stomach.

Sensitivity to Sunlight
Three types of porphyria are associated with a sensitivity to light, which can be as extreme as sever sunburn at minor exposure. Most sunscreens are totally non-effective.

Complexion
Most legends suggest that vampires are very pale in complexion. Maybe because the legends state they dont get out much during the day? Most people suffering from porpyria are very pale in complexion as a result of barely functioning red blood cells.

Despite all this there are a few bits where the legends dont match up to the medical condition. As far as medical science is aware porphyria suffers cant fly. Also the legends all seem to give vampires a far eastern european accent. Porphyria is one of surprisingly few condtions that dont seem to effect any ethnic group more or less.

This connection has been suggested in the past by many academics one of the better works was a paper writen by a biochemist named David Dolphin in 1985. These suggestions are deeply contravercial as it adds an additional stigma unto suffers of what is in reality a very natural and saddening condition.