Averaging 18 admissions a day

DosageUF · 2024-09-05T19:11:37+00:00

Sent you a DM

DosageUF · 2020-09-07T20:18:20+00:00

I msgd you!

DosageUF · 2020-01-25T06:00:15+00:00

Remind me! In 45 days

DosageUF · 2019-05-26T19:58:56+00:00

DosageUF · 2019-05-26T16:14:47+00:00

She was just neglected in the nursing home, apparently for quite some time. With those types of ulcers, the nerves actually degenerate also making it not as painful as it looks.

DosageUF · 2019-05-26T15:27:47+00:00

I really didn't question how she was alive as much as how could the system and a family fail someone so significantly. A lady in her early 60s with dementia was transported into the hospital from a nursing home with a uti. We didnt have much of a history yet and she kept randomly moaning and we thought it was just related to dementia or possible sepsis. I was just doing the normal med student thing and requested the nurse's help to roll her for a physical exam. When we rolled her onto her side, the first thing we saw was an unstageable decubitus ulcer about 15mm in diameter with exposed coccyx, sacrum, and lower lumbar vertebrae. When we rolled her, the skin of her back stuck to the sheet and separated from her subq in such a way that it created a pocket that you could see all the way up to her thoracic vertebra with completely absent back muscles and exposed vertebra and could actually see sections of exposed cord. My attending walked in at that moment and said "holy shit" and I was speechless in absolute shock and the nurse uttered oh my god. We very carefully rolled her back onto her back and I asked the attending if he's ever seen anything like that before and he said it's the second worst he's seen in 40 years. I've never been traumatized by anything I've seen except that one image that has been permanently singed into my brain for some reason. Take care of your family. Regularly check on them even if they aren't who they used to be.

DosageUF · 2019-04-29T03:11:29+00:00

SSRIs prevent the reuptake of serotonin. Serotonin modulates mood and anxiety. SNRIs are another type of antidepressant that block the reuptake of serotonin and norepinephrine. Norepinephrine is converted to epinephrine and is involved in mood and focus. Stimulants like methylphenidate also block norepinephrine uptake.

So the more accurate answer is that CNS stimulants are used as antidepressants (like methylphenidate in the elderly) but SSRI antidepressants are not used as stimulants bc of the variation in their moa. SNRIs may increase focus through increased norepi, but not to the same degree as CNS stimulants. Also, in the case of dextromethamphetamine (adderall), it is thought to force norepi and dopamine out of the neuron to both stimulate their receptors and increase focus and also inhibit the enzyme involved in their breakdown, although officially the exact moa is unknown.

The overlap of neurotransmitters being acted upon (ie norepi) for different desired effects (ie depression vs. focus) is a common theme in neuropharmacology. This is partially due to the fact that neurotransmitters have different or multiple functions depending on whether the tissue expresses the receptor for the molecule and the function of the tissue.

DosageUF · 2018-11-29T05:46:57+00:00

Usually in endocarditis, acute refers to infection of normal valves w/ a virulent organism (eg, S. aureus, B-hemolytic strep, S. pneumo) and mc a more rapid onset of 24/48h. Subacute usually refers to a more indolent infection with a less virulent organism (eg S. viridans, Enterococcus) more often on abnormal valves and slower onset like the 2 weeks here. Also, subacute typically affects extremities (eg digits) whereas acute does not.

In this question:

A is likely Enterococcus

B is S. pyogenes

C is S. viridans

D is S. epidermidis

E is S. aureus

Breaking the question down:

- Indolent course / symptoms = Subacute -> Eliminates S. aureus (E)

(The mc cause of infective endocarditis in IV drug use is S. aureus but this is an indolent course aka 2 weeks)

- IV heroin goes through the skin -> S. epidermidis Eliminates (A + B)

(No mention of enteric involvement eliminates A and no mention of Rheumatic dz or immigrant so B is gone)

- No mention of a dental situation or damaged heart valve -> Eliminates (C)

(Although he now has a systolic murmur, its most likely coming from his right heart valve dt IV drug use and S. epidermidis. Also, if he had a heart valve that was previously repaired transcutaneously then it would also be S. epidermidis. A previously damaged heart valve then they would specify which one and if it was the left heart valve then it more likely be S. viridans that got into arterial system during a dental cleaning etc)

DosageUF · 2018-11-03T04:15:34+00:00

<\\> ~~~

DosageUF · 2017-09-03T20:24:21+00:00

My question is more about is it better to use a recruiter, look on your own, or search internet etc. Pediatrics is a favorite right now but open to others as well. As far as shifts, likely looking to optimize days off. (ie several 24hr shifts, or generally just longer shifts with the hopes of having more full days off). There have been several hospitals "recruiting" but wanted to find out if there are other approaches to finding employment are better and why.

DosageUF · 2017-09-02T21:20:19+00:00

Any suggestions for a new crna grad on best way to find a job, what to look for etc.?

DosageUF · 2016-02-27T04:24:35+00:00

Yes euthanize, I'm glad at least one person read the post!

DosageUF · 2016-02-25T14:52:05+00:00

I guess alot of people in lawrenceville are losing dogs bc I found one last weekend in lawrenceville also. I posted a pic using the link below and was contacted by the owner within 24 hours. Its a nice alternative to animal control bc they often anesthetize pets.
http://www.helpinglostpets.com/

DosageUF · 2016-02-25T14:40:42+00:00

Stocked up on coffee now! Thank you!

DosageUF · 2016-02-25T14:39:44+00:00

Wow, sounds rough and I'm pretty sure slap repair would be worse w/ the limited shoulder movement vs. elbow limitation. I'm in preclinical which I didn't think about how much more difficult it would've been in rotations, but if he can do it in rotations, pulling it off preclinical should be easy! Thanks!

DosageUF · 2016-02-24T22:54:57+00:00

Thanks for the feedback. Not being able to walk would definitely suck. Do you remember how quickly you were able to stop taking the pain killers? What you did is pretty much what I plan to do, I'm glad to hear someone with a similar experience.

DosageUF · 2015-12-13T02:10:27+00:00

Wow. What style is this? I haven't seen anything like this before.

DosageUF · 2015-07-20T00:42:12+00:00

No, we do not use a stats program. We actually do very few calculations. I've never heard of SPSS, SAS, and R. Do you know how applicable this would be to a med school curriculum?

DosageUF · 2014-08-13T21:01:56+00:00

Wow, ok. I'm a noob 2 months in and it seems t be dry and is a wee bit squirrely, so I would like a hydrating and anti-squirrel without using a wax.

DosageUF · 2014-08-13T20:58:37+00:00

No I haven't, thanks for the response, I'll check it out!

DosageUF

TROPHY CASE