Week 18: Thump…Thump…Thump

          All fell silent as I donned my stethoscope for its first use. Wrapping the blood pressure cuff snugly around the arm of my “patient” (a classmate), I was finally prepared to acquire my first manual blood pressure measurement. After inflating the blood pressure cuff to a sufficient pressure, it came time to listen very, very carefully. Little by little, I dropped the pressure of the blood pressure cuff. Little by little, a little more, and more, and finally, two low-pitched thumps interrupted the few preceding seconds of silence. Thump…Thump…Thump. With my stethoscope in place, I continued to drop the cuff’s pressure and listened as the consistent low-pitched thumps continued, until all fell silent, once again. And that was it. I recorded the pressure at which I heard the first two thumps (systolic pressure), in addition to the pressure at which the thumping sounds disappeared (diastolic pressure), put a line between the two numbers, and there it was–my patient’s blood pressure.

          As you might have guessed by now, this week in Clinical Skills, we began our two semester long journey through the procedures that we will perform during a physical examination of a patient. This week was all about measuring and recording vital signs, from blood pressure and temperature to heart and respiratory rate. Interestingly enough, we learned that the physical examination of any patient begins long before a blood pressure cuff swings around his or her arm. From the moment we enter the exam room, we begin our assessment of the patient. Everything from the patient’s sitting position, clothing, facial expression, and eye contact to his or her odor and body movement patterns need to be assessed. In fact, a patient’s assessment may begin as early as our spotting him or her in the waiting room. So, the general survey and vital sign component of the physical exam is not as simple as accurately acquiring four measurements; much of the patient’s psychosocial status needs to be evaluated at this same time as well.

          This week was another short one. All of these snowstorms have really slowed things down at school (not that I’m complaining), but we have been doing well with making up for all of the lost time. The only other course held this week was Endocrinology, in which we focused on disorders of the thyroid gland (hyperthyroidism and hypothyroidism disorders, as well as thyroid cancers). Other than that, it was a great catch-up week. I have been frantically preparing for my EKG exam, which is next Friday. I can’t believe how soon it is! I’m averaging about 100 or so EKG analyses per day, so I’m hoping by next week I’ll be confident enough at exam time. Anyway, I’m trying not to get too used to these consistently short weeks. Next week, if all goes well, all seven courses will resume once again.  

Question of the week: Some patients have blood pressures, which rise above normal range only when measured in the setting of a medical office. What type of hypertension (blood pressure) does this phenomenon describe?

Last week’s answer: Type 1 diabetes mellitus is an autoimmune disease in which the insulin-secreting cells of the pancreas are negatively affected. 

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