Weeks 52 & 53: The Final Spring Break

At last, spring break has arrived (my last spring break ever), and, needless to say, it has been great to relax a bit especially after midterms. The past few weeks got a bit hectic (main reason why I never had a chance to post a blog), but all of my midterms went smoothly, and my research group (for my Master’s degree) received IRB approval (the institutional review board of the college) to move forward with conducting our research study. So, I’m nearly ready to get back to school and finish these final seven weeks. It feels so great to be able to say that…

In the final week leading up to midterms (Week 52), each course covered one final bit of information (more than a bit, I guess) before exam time. In Emergency Medicine, we focused on the treatment of neurological emergencies (stroke, seizures, head trauma…etc.). In Family Practice, we reviewed the outpatient work-up and treatment of hypertension, chest pain, and chest palpitations. In Pathology, we learned the cause for and manifestations of various forms of anemia and leukemias/lymphomas. Pediatrics shifted focus from infant care to toddler and adolescent care, focusing on psychiatric disorders (depression, schizophrenia, conduct disorder…etc.). The newest procedures learned in Clinical Skills, included urinary bladder catheterization and airway management (intubation). It’s so awesome to finally learn the steps for performing these procedures. Of course, we practiced these two procedures on anatomically correct models, and not real patients, but it will definitely help knowing these steps once I’m out on rotations. Finally, for my Clinical Decision Making course, my group received our next medical case to solve. This time our patient presented to the emergency department with fever and fatigue…and that’s all the clues we got, so this case will definitely take a more extensive work-up to figure out what’s actually going on…

As far as the research project that my group and I can finally move forward with, data collection will most likely begin at the end of this month or early next month. As alluded to a bit last semester, our research topic involves anterior cruciate ligament ((ACL) a ligament within the knee joint) injuries and their high prevalence in college level athletes. Although many of these injuries occur following direct trauma to the knee, most actually occur without contact to the knee, which suggests that such injuries are preventable if the muscles and ligaments, which support the knee, are strengthened through training and exercise. So, my research group has found a training program researched and designed specifically to prevent ACL injuries in athletes by strengthening the structures supporting the knee joint. We seek to survey college coaches (2,000 +) of soccer, lacrosse, basketball, and skiing teams (these are the sports with the highest rates of non-contact ACL injuries) across the nation to see how many of the components of this ACL injury prevention program they integrate into the training regimens of their own teams. If there is an identified correlation between the extent of the prevention program used and the number of ACL injuries that have occurred on each team, then we hope to be able to recommend implementation of this program or others of the like to help prevent these avoidable ACL injuries. With time lost, money spent, and significant medical recovery following an ACL injury, such cost-effective and successful ACL injury prevention programs may benefit all athletes of high-risk injury sports. We’ll see how this progresses over the next year…

I survived my midterms, so here’s a midterm for you:

  1. True or false: Atrial fibrillation exhibits a faster heart rate than atrial flutter.
  2. What is the most common, preventable, injury-related cause of death in children?
  3. Insulin injections are given: intradermally (into the skin), subcutaneously (between the skin and the muscle), or intramuscularly (into the muscle)?
  4. True or false: It typically requires the same amount of compression time to stop bleeding from a vein relative to an artery.
  5. Bonus: What specialty did I choose for my elective rotation?

Last week’s answer:  You just completed an arterial blood draw on your patient. After withdrawing the needle from the artery, you should apply at least 10 minutes of pressure over the puncture site (on average, but varies from patient to patient).

Clinical Phase Countdown: 71 days, 6 hours, 52 minutes (getting just a bit more eager)

Weeks 50 & 51: The Resuscitation

I, and three of my other classmates, stood beside our ‘patient’ (a mannequin simulating a real patient), and prepared for our practical assessment, which we would all have to pass to acquire our advanced cardiac life support certifications. Rotating as team leaders we would each have to lead each other through the resuscitation of a patient undergoing a cardiac arrest, with each team member performing a specific task (providing ventilation/intubation, chest compressions, and/or administering intravenous medications). The instructor informed me to assume my position as team leader, and my practical began…

My patient was an elderly male, presenting to the emergency department with chest palpitations. The instructor held an iPad, which displayed all of the patient’s vital signs and his EKG rhythm. There was also settings available if/when it became necessary to defibrillate/cardiovert (reset the heart rhythm) the patient. My patient initially presented with atrial flutter (a rapid, abnormal heart rhythm), so I initially instructed my team members to administer the appropriate medication in an attempt to slow the rhythm. Unfortunately, the treatment of this patient was not as simple and quick as giving a single dose of medication. Before I completed my practical, this same patient experienced a myriad of other rapid, abnormal heart rhythms, lost his pulse a couple of times, and then finally after chest compressions, air delivery, medication pushes, and several rounds of re-setting his heart rhythm (with shocks), the patient revived and his vital signs stabilized. It was a long five minutes, but it was such a cool simulation…

Over two Saturday sessions, nine hours each, my classmates and I attained our advanced cardiac life support certifications, which we needed prior to starting rotations. We all received our basic life support certification (CPR) prior to beginning PA school, but advanced life support adds medication use, EKG monitoring, and more invasive methods of breathing aid (intubation) to the mix. As described above, at the end of the course, each of us had to demonstrate that we could lead a team through the resuscitation of a “pulseless” patient with the information we learned. I always marveled (and still do!) at dramatic scenes of medical TV shows, especially at how the clinicians know exactly what instructions to give, equipment to use, and medication doses to prepare, in an attempt to revive a patient. It was just so surreal to be given the task of performing similar actions in this setting.

Aside from the extra weekend time spent at school, we covered a lot (what else is new?) of new information in each course. In Emergency Medicine, we focused on the treatment of infectious disease emergencies (fever, meningitis, skin infections, HIV exacerbation and associated infections), as well as OB/GYN and reproductive emergencies (testicular torsion, ectopic pregnancy, emergency delivery…etc.). In Family Practice, we focused on outpatient treatment of diabetes and thyroid disease. In Pediatrics, we continued to focus on infections that can occur throughout infancy, in addition to genetic syndromes (Down syndrome, Turner syndrome, Marfan syndrome…etc.). In Pathology, we focused on the causes and derivations of cardiovascular and respiratory disease states. Finally, in Clinical Skills, we learned how to perform arterial blood draws (used mainly for assessing oxygen and carbon dioxide levels). We did not practice this on each other, as we did for drawing blood from veins, because this procedure is a bit more painful, and also has an increased risk of bleeding (since the blood within arteries is of a higher pressure relative to veins). Instead, we practiced on arm simulators with fake blood and pulses.

Already six weeks of the semester are down! Midterms are right around the corner…

Question of the week: You just completed an arterial blood draw on your patient. After withdrawing the needle from the artery, approximately how long should you apply pressure over the puncture site? 30 seconds, 10 minutes, or 45 minutes

Last week’s answer: You just received an injection of your annual influenza vaccination. This injection was an intramuscular one.

Clinical Phase Countdown: 93 days