this is my pet penguin.

Click to visit my Haikoo^SM Zoo pet, smunchy, on Facebook!

time for me to go to bed.

i am now in the SICU, which is neato. but frusturating, very hard to keep up, on call i am essentially responsible for up to 12 critically ill patients....anyway, the really crappy part is that we are on call q3 (every 3rd day, i am on call, so, for instance, this week, saturday i went to work at 6am, got off sunday at 10 am, monday i worked 6am-1pm, tuesday i work 6am till wednesday at 12 noon, thursday i work 6 am - 12 noon or 1pm, friday i work 6am till 12 noon saturday, and i am off sunday), ROCK ON! as you may imagine, this makes duty hours of <80/week a joke....but, i do still like the SICU, if i had to do this on a medicine ward or something as crappy as my last month (general surgery) i would be crying a lot, at least this is interesting. but, q3 should be illegal!

very poor SICU planning, last month there were 11 or 12 residents in the SICU, this month there are 6, and one is on a different rotation schedule, so for the last week or so ther will only be 5.

BLAH!

i am working with a chief resident who i did not know terribly well prior to this rotation, but i had spoken with him several times in the past, and he seemed like a neat guy. you can imagine how i was surprised when in the first few days of the month (when my chief was out of town) numerous people told me he was a lazy little shit.

this brings me to....the first 6 hours of my rotation i had a senior resident, but he was post call, and was going to go out of town for two days after, so after he left at noon on thursday he was gone until sunday, and my chief was out of town for the first three days. SO, for the first nearly 3 days of the month i, an anesthesia intern, was the entire surgical team.

moving on, i have come to find that my chief shows up to rounds AT THE EARLIEST 30-45 minutes late, more commonly, 45-60 minutes late. he is also the first to leave at the end of the day, and offers excuses throughout the day about why he hasn't, doesn't or won't do various things.

i was off this past weekend, and when i returned monday morning i got a phone call from a nurse regarding a patient who had had an operation several days previously and was still on a dilaudid pca (read, strong narcotic by vein that is administered in small doses when a button is pressed), and she had her nurse call to see if she could get MORE IV pain medicine. since my senior resident (this is a different one than i mentioned from the first day, that is another story, lukily this guy is nice and a hard worker from what i can tell) and chief were standing right there, i asked if we were still giving her IV meds in addition to her pca (this is the first time i have ever heard of this being done, and essentially misses the point of the pca, and i disagree with it personally as well, i came upon intelligence that this patient abuses narcotics--i suspected it from the beginning, but ran into a medicine colleague who took care of her on 2 admissions in december, she sent the patient home after the first admission with 30 days worth of long acting morphine pills and percocet pills, and when she came back 10 days later, she said they were all gone--ANYWAY, this is highly unusual). after telling the nurse that i would put in an order for more pain medicine i asked my cheif/senior-->I WILL FINISH THIS ENTRY LATER 8), wait with bated breath

Last month was total hell, I was on general medicine wards and it was SO painful!!
I'm in the ED now. It is something about which I feel highly mixed....I did my 1st ever LP on medince last month, and have done 2 in the ED this month, the 1st one in the ED was a chapmaigne tap (no red cells) an the R4 (senior resident) who supervised me for that brought my a bottle of champaigne today, which is neat 8)

I have had an upper respiratory infection for 12-13 days now, which is fucking ridiculous!!!

I am off for the next five days, which is awesome. I have several little diddies planned, visit to the dermatologist, dinner with my parents, dinner with neals mom and myra, dinner with the guys, dinner with anesthesia recruits....and sleep. Finally writing my thank you notes from Christmas, get an oil change for my awesome car....

OK, I don't have anything else to say, and so far haven't really said anything at all anyway.....

Hope things are going well for you.

Things are going swimingly. I'm on neuro right now, desperately trying to disguise the fact that I only know a few things about neuro:
1. Ativan for any signs of seizure. If someone does rapid alternating hand movements too fast on my neuro exam, I generally just jump to a propofol gtt. Why waste time with pansy ativan and dilantin - when you can fix it and forget it? ...plus I get another intubation.
2. Weakness, numbness, confusion, cortical blindness, left sided neglect, whatever - can be treated with a simple aspirin.
3. TPA first, ask time course and get the CT later. If you hit someone with tpa and they have a hemorrhagic bleed, chances are that a good thin slice CT can close the vascular insult anyway...

On to your problem. Air is tricky! Suprisingly, you actually can damage other tissues with the radiation dose needed to eliminate air. The risk is low, but I think I have a better way.

Simply start an IV (a central line might be faster) and hook it up to continuous wall suction. You may need to crank up the suction in order to overcome cardiac output. When you are getting close to sucking out the air, you may need to chemically stop the heart - that's something you'll have to discuss with the cardiologists - they're the experts in that sort of stuff. Once you have the air, simply replace the blood. Due to the theoretical risk of hypotension with this method, you should place the patient on ice and chill the patient below 92 degrees (yes, that's rectal, NOT axillary or oral!) prior to starting.

As for the septal defects, I believe there is some interesting work being done with gene therapy. In essesense, we can develop a drug to induce the genetic disease asymmetric septal hypertrophy. Done and done!

Thank you for this interesting consult. Will follow peripherally, please call with questions.

later,
Brian
---JODI'S REPLY--
Maggie,
I've been thinking about your predicament. Here is what I've come up with (and no worries, this could totally be done at the bedside. 20 minutes tops). I say go for the median sternotomy and the malleable retractor is a must. I like the aspirating from the RV too, but instead of cutting into the RA here is what I think you should do. Do you know those toothpaste tube roller upper things? You know, the ones that squeeze the toothpaste from the bottom of the tube up? I think you should apply one of those to the PA and roll it along until the embolus is in the RV, then put a clamp on the site, so the air can't move back into the PA. Now luckily, you will have that malleable in place, so the air in the RA can't possibly travel through the ASD. Then I would recommend having the patient stand on his head, so that the air from the RA keeps with the laws of physics and travels to the RV, then it should be absolutely no problem to suck that air out. Also, since blood is liquid!
you would have the added advantage of it following the laws of gravity, and traveling in the opposite direction of the air (down) making it easier to suck the air without getting the blood. Problem solved! I would finish up by applying some radiation to the sternotomy site, for good measure.

and this is her also wearing her underpants so she doesn't scoot and pull at her stitches--or at least, if she scoots it isn't quite as damaging....she started scooting about 60 seconds after the vet told us that this sometimes happens with doggies with itchy butts after anal gland surgery

jayna b is a cute doggie and i love her very much, she is demanding though, takes up a lot of space on the couch and whines more than her fair share, but she is so very cute!

i do anesthesia next month which should be good, diana has had her own room a few days, which is scary, but aparrently the attending didnt leave her side, so that is good, though she had a borderline attending, so hopefully that wont happen.

had a brief moment of catatonia a few days ago thinking, god, i am sick of this 60-80 hours a week, i am sick of call, i am sick of never having 2 consecutative days off and i am only 2 months into it....and then i realized, it is going to be this way for at least 4 more years! in anesthesia here since there are only a total of 18 residents, you take 7 to 8 calls per month, which is a lot, and work at least 80 hours a week for your first few months as a CA1 here...this is the thing that sucks about UC, since there is such a big CRNA program there are relatively few MDs in training....so, hat sucked and was painful/sad to realize

got a haircut recently, which was exciting. also got my hilights redone, that has received fairly mixed reviews but i like it, though i do think i like my hair brown better, regardless of which color it is i always want the other, which is frusturating and expensive.

i should take a shower now...we are going to the dentist this afternoon, hopefully i dont need a lot in terms of fillings but i was told a year ago i had a cavity so i am not optimistic

a few days ago i woke up and my upper lip was swollen, and it sitll is, and it feels weird and like burning and i dont know what is up with that.

talledega nights was hiLARious!

more pictures to come.

started orientation for my internship last week. we start on wards wednesday, i am not exhilarated about it, i am fairly scared....
we shall see

Jayna is a neat girl 8)

neal and i got a new baby the other day, her name is jayna.
she is a one year old lab german shepard mix, she is a big girl, weighs about 60 pounds. she has yellow eyes and giant feet.
she is very very cute, she is shy around new people and has found a host of hiding places that she believes make her invisible, even if you are looking right at her 8)
she likes chewing things and has only chewed one thing that was not her own (neal's wallet--a funny object to choose).
just a minute ago she was holding her favorite bone while chewing on her second favorite bone 8)
she is a neat and snuggly girl who occasionally will allow us to sleep in our own bed, though yesterday morning she shoved neal out of bed.