Cardiac Arrhythmias (I)

Its no secret that Cardiology is my one-true-love. :)
I love it so much, I'm going to specialize in it, Insyaallah...

All of my favourite Internal Medicine teachers were great at teaching Cardiology, which I think definitely inspires me and a lot of my friends here to study well in this field. To name a few names, Elena Ivanovna Panova, Tatyana Anatolevna Nekrasova, Ilya Gregorevich Pachenko and my current teacher, the HOD of Cardiology, Svetlana Nikolaevna Botova. Dr. Nekrasova is an Endocrinologist by profession, but her knowledge of ECGs and Cardiology is extremely good. :)

Since yesterday was so cold, my group made a sad face and asked the HoD for a one-day break. If other groups want to call us "weak" and "lazy" so that they can appear as "hardworking" and "strong-willed", this is the chance for you to do so. The buses here were not heated AT ALL, and taking the bus for an hour is like sitting in the freezer. And upon reaching the bus stop, there was a 10-15 minute walk to the hospital in frigid cold weather of -27C. So yeah, I am weak. Lazy? Well, let's not go there. xD Let's call me....easygoing? Haha.

Anyway, today is officially my ECG day. Interpreting ECGs is not an easy job, for a medical student. For the cardiologists who picked up their first rhythm strip when I was in my diapers, of course its easy!! ^^

Here's a few pointers I learned from my attendings, esp. Ilya Gregorevich Pachenko, a.k.a. Bradley Cooper a.k.a McDreamy a.k.a. God of 4th Floor, 13th Hospital. Sometimes people refer to him as I.G.P or as the HoD~

Step 1 : Calculate rate

-          Count the R-waves in a 6-second rhythm strip and then multiply by 10

-          Find R waves that land on a bold line. Count the number of large boxes to the next R wave. If the 2^nd R is 1 large box away, the rate is 300, 2 box = 150, 3 box= 75, etc.

Step 2 : Determine regularity

-          Look at R-R distances

-          Regular (are they equidistant apart?), Occasionally irregular? Irregularly irregular?

Step 3 : Assess P waves

-          Is P wave present?

-          Do they look alike?

-          Are they regular?

-          Is there a P wave before each QRS?

Step 4 : PR interval

-          N: 0.12 – 0.2 seconds (3-5 boxes)

Step 5 : QRS duration

-          N: 0.04 – 0.12 seconds (But acc to Ilya, 0.04 – 0.10, not 0.12)

He He loves these 5 steps! :)) 

• Sinus Tachycardia is rate >100bpm (with sinus rhythm of course)
• P wave amplited often INCREASES and PR interval often DECREASES with increasing HR
•  RBBB, Complete has a QRS duration of >0.12 seconds
•  Secondary R (R') wave in lead V1 is usually taller than the intial R~
• ST segment depression and T inversion in leads V1-2
• QRS axis is usually normal!
• RBBB does NOT interfere with the ECG diagnosis of LVH or Q-wave MI (unlike its counterpart, LBBB)
•  Left Posterior Fascicular Block is diagnosed when
• RAD with mean axis between 100-180 degrees
• QRS duration between 0.08-0.1 seconds
• NO OTHER EXPLANATION for RAD is found (important~!)

• RAD explanations
• RVH
• Vertical Heart
• Emphysema
• PTE
• Lateral wall MI
• Dextrocardia
• Lead reversal
• WPW

 :) Are you having fun yet? Yes?? Hehe...Good, because Cardiology IS fun!! ^^ Most of the times anyway... ;)

You Bet Your Youth

10 years ago I hated science and wanted to become an accountant.

7 years ago, I thought Pharmacy would be better suited for me.

But 6 years ago, I enrolled in Medical School.

Why? 

To tell you the truth, I don’t have the answer for that. Not anymore. In the beginning, I was inspired by the late-night documentaries I watched about MSF volunteers and Chicago Hope re-runs (I wasn’t and still am not a fan of E.R.). I wanted to save lives.

It all sounds so cliché now!

With all my whining and complaints, I actually do still want to be a doctor. I just have no idea WHY. 

The first day of medical school seems like such a long time ago. And at that moment, I couldn't wait to be here. At this moment. Months away from graduating. The six-year wait have been fun and surprisingly, fast. As a 17-year-old, all I wanted to do was skip to the good stuff. Skip to the part where I learn how to take care of sick patients in the hospital. And now as a 23-year-old six years later, I find myself still wanting to learn that very same thing. 

In some months I'll be driving up to the hospital and reporting myself for duty. And I know it'll only be a few weeks or months from that point in time before I get burned out and exhausted and feeling like every new patient is my enemy. I'll be so tired from all the night calls and 36-hour shifts. And I'm so excited to start!

Finally I get to see what six years of hard work got me. I get to do what I signed up for - treat patients!

Of Surgery and Pancreatitis...

It has been a grueling rotation indeed.
Previously, if I was asked to describe my Surgery rotations knowledge, these words would come to mind

"Easy.."

"Boring.."

"Non-existent"

But after a hard-core month with Professor Yurii Markovich Zigmantovich, I changed my mind!
Damn, surgery is HARD!

To recap, our days with the dear Sir would start early. I don't mean 9am. I mean 8.30am. NOT 8.31am. And definitely NOT 8.45am like other (more fortunate) students. But 8.30 am sharp. And when you're late, you don't get a dirty look and snide remarks. What you get is a boot out the door. Yeah, go home and go back to sleep because he doesn't accept tardiness!

And if the early mornings are not bad enough, we have tests...not everyday (like he threatened) but at least once a week. Usually on the bigger topics like Dysphagia, Post-Gastrectomy syndrome, Pulmonary embolism, etc etc. But I don't mind it so much, because at least it forces me to study. :))


Pancreatitis
In the past 2 weeks, I have had 3 patients suffering from acute pancreatitis! :p That's one too many for me. I want to clerk something more challenging but instead...I'm pancreatitis girl!

Here are some fast facts for my benefit :

• Most common cause : Alcohol abuse and Gallstones
• Least common cause : Scorpion bite! xD
• C/o of acute epigastric pain, belt-like irradiation, nausea and vomiting
• adynamic ileus (sentinal loops on CXR) on auscultation
• Tender epigastric
• Fever
• Patient should be NPO! 
• Analgesic of choice? NOT morphine (it causes the Sphincter of Oddi spasm)
• Prognosis based on Ranson's criteria
• At presentation
• Age >55
• WBC > 16 000
• Glc > 200
• AST > 250
• LDH > 350
•  During first 48hours
• Base deficit > 4
• BUN increase > 5
• Serum Ca++ < 8
• Hct decrease > 10%
• P02 < 60mmHg
• Mortality rate is about 100% if Ranson criteria is > 6

First Day

Its a new year, its going to be a new (okay, old but with new improvements!) me!

SO...


its my last year in medical school

its all ending.

and soon too.

6 more months.

January is going to be Surgery month. I'm doing great so far, but I've got a lot of reading to do especially if i want to cover Traumatology and Paediatric Surgery before the new semester starts.

Will update tomorrow about Pancreatic Cancer. :)