critical medical care

takestheweatherpersonally  asked:

Hello! I have a character who's five years old and I was wondering what difference that makes medically, if that makes sense? Both like how medical workers will act with her and explain things given she's very young and how that would factor into her medical care, like basic checkups or diagnosing illnesses and stuff like that. Sorry if this is too broad or vague, and thank you for all you do!

Hey there! Congrats on being Janey on the spot with the inbox and  being the first ask of June! 

So, one quick note. I come from EMS, and particularly now from a critical care service that handles a lot of kids. But I’m assuming for the purpose of this ask that this child is not and has never been critically ill. Okay? Okay! 

Pediatrics is its own specialty for a reason, and I have bundles to learn about it. There are all sorts of things that are different in pediatric medicine (and all sorts that of things that are shockingly similar!). 

First, let’s talk about “furniture.” As you’ll remember from having once been a child, peds doctors offices and clinics, and even ERs, are often bright, colorful and cheery places. Kids get offered toys and lollipops, they get to see special movies. Doc McStuffins is a very common sight in peds hospitals and waiting rooms. 

I’ve heard of peds hospitals that have different mural styles for different wards: one hallway that’s done all up in a baseball theme, another in a princesses and dragons theme, another in trains. 

Oh! When little kids get a nebulizer treatment, oftentimes now the mask they get the treatment through looks like a dragon and it’s awesome and I wish they came in adult sizes. 

Providers are also, by necessity, gentler with kids. You can’t argue with a kid and tell them to hold still; they’re going to squirm whether the shot is good for them or not. (Don’t get me started on vaccinations, please.) 

In terms of the medicine, as someone who works on a pediatric critical care unit, there are two ways you can look at kids. 

A) They’re just little adults. 

B) They are definitely not little adults. 

Both are true. They’re little adults in that they have the exact same functions as adults. They’re not little adults in that there are big social development changes that go on at various ages and there are some physiological changes (mostly that come up in very technical fields) that are different. 

For adults, a lot of the med doses are standardized; for kids, they’re almost all weight-based. A 5 year old should weigh roughly 20kg/45lbs (and there’s a really neat method called Handtevy that will give you the estimated weight of any kid up to 10 yrs old based just on their age; it’s stupendously cool and exactly the kind of thing pediatric critical care medics nerd out about!). 

IVs are almost always smaller in kids, but that’s because they’re little. I’ve also seen ERs use whole teams to get a single IV in a child, including someone singing happy songs while other people stab the child with needles. (It seemed seriously Clockwork Orange to me, but I have a feeling it’s data-driven with good outcomes, so who knows?) 

I get the feeling you’re asking about pediatrics in general and not pediatric critical care, so I’m going to try and focus on the general practice stuff, which is that kids who don’t get seriously ill tend to do pretty well. 


Some things they might have done at the doctor’s office if they’re not there for a specific illness: 

  • Vitals: blood pressure, pulse, oxygen saturation, temperature
  • Height/weight checks. 
  • Scoliosis checks. 
  • Vision and hearing checks. 
  • Immunization checks. (I’d say just check the immunization schedule recommended by your region; the CDC’s is here and is as good as any.) 
  • Allergy scratch-testing 


Common reasons a 5 y.o. will go to the doctor: 

  • Earaches and ear infections
  • Fever (usually the flu or an ear infection) 
  • Vomiting 
  • Asthma. This is incredibly common in some areas, and I’ve worked in a few. 
  • the snot. so much the snot. 
  • Something lost in the nose 
  • Something swallowed 
  • Mechanical injury (broken wrist, bumped head, etc.)  It’s common for good parents to be suspected of child abuse for having clumsy kids. 

Kids tend to bounce – both literally and figuratively. They’re little, but pretty tough and hard to injure, and when they do get hurt they heal pretty quickly. They’re still growing, so they do well. 

That’s all I can think of about pediatrics when it’s 2 in the morning and I worked a 14+ hour day! 

Congrats on getting there first and I hope this was what you needed. 

xoxo, Aunt Scripty 

(Samantha Keel) 

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life decisions: I see you

After a month back on the floors (two-week electives in cardio consults and the intensive care unit), I’ve grown back into the medical student role and then some. The world feels right and balanced again. I got to take Step 2, finally, but am part of the group that won’t be getting scores ‘til mid-September.

I’ve also decided to go into internal medicine. Definitely going to do a pulmonary/critical care fellowship afterwards. The ICU gives me life. It has the urgency and hands-onness that I loved about surgery and OB/GYN, but all of the thought and diagnosis and differentials of medicine. It is patient-focused. It is a good combination of evidence-based practice and all-hell-is-breaking-loose-let’s-do-this. I truly love it.

And thank you all for your love and welcome backs. It’s nice to be here again.

On the horizon: two weeks each of neuro ICU, emergency medicine, and palliative care. Also finishing up my personal statement and collecting letters of recommendation.

Pharmacology… I think I have it covered!!! Better living through Pharmacology! ;-)


63 Xanax 0.5mg
18 Adderall 20mg
7 Adderall 30mg
3 Tramadol 50mg
9 Prednisone 20mg
10 Tylenol #3 30mg
1 Ativan 0.5mg
2 Oxycodone 30mg
17 Norco 7.5mg
49 Norco 10mg

Am I abusing the system if I use birth control to stop having my period?

Someone asked us:

I was wondering, is it considered abusing the system if the main reason I’m on birth control is to not have a period because of dysphoria? (I’m a trans male) My doctor doesn’t know I’m mainly using it for that but I feel kinda bad. The state I’m in doesn’t accept transgender people so I have to lie.

Oh dude, please do NOT feel bad about using birth control to get rid of your period — that’s a super common reason people use hormonal birth control methods in the first place! And as anyone with problematic periods will tell you: anything that eases troublesome menstrual symptoms is critical and necessary medical care.

Birth control has so many benefits besides, well, birth control. Lesbians use it. People who don’t have sex use it. Trans guys use it. In fact, up to 58 percent of people on the pill rely on it for reasons other than preventing pregnancy. Clearing up acne, easing PMS symptoms, controlling the timing of your period, and reducing menstrual flow are all perfectly legitimate reasons people use contraception. And you are just as entitled to these benefits as everyone else.

Now, about lying to your doctor. I totally understand how it’s tough to be open when you’re expecting and fearing discrimination. But it really is important to be honest with your doctor (if possible) so they can give you the best care. 

You may be able to find a trans-friendly doctor in your area — Planned Parenthood health centers are a good place to start.

Being clear about what you want out of your birth control helps your doctor prescribe the best method for you. But even if you’re truly not okay with coming out to your doctor and can’t find a trans-friendly provider, you don’t have to lie about wanting to use birth control to get rid of your period. 

So PLEASE stop feeling guilty about this right now, okay?

-Kendall at Planned Parenthood

youtube

Some of you may have seen this before, but it’s still so powerful. A woman talking about her experience as a ICU patient and the nurse that made all the difference in the world to her.

npr.org
Chelsea Manning will receive gender confirmation surgery in prison
Manning, a transgender soldier imprisoned in Kansas for leaking classified data to WikiLeaks, says the U.S. Army has agreed to allow her to get medical treatment for her gender dysphoria.

Chelsea Manning is about to be the first person in prison to receive gender confirmation surgery.

Last week, Manning began a hunger strike to protest her unfair treatment while in prison, particularly the lack of attention to or respect for her transition. Her doctor recommended gender-affirming surgery back in April.

Lengthy but important excerpt from this news article:

To date, the ACLU says no transgender individual has received gender-affirming surgical treatment in prison despite medical recommendations for such care in prisons across the country.

Army officials have not commented.

Manning said in a statement released by the ACLU:

“I am unendingly relieved that the military is finally doing the right thing. I applaud them for that. This is all that I wanted — for them to let me be me. But it is hard not to wonder why it has taken so long. Also, why were such drastic measures needed?”

In 2014, the ACLU filed a lawsuit against the Department of Defense over its refusal to treat Manning’s gender dysphoria.

“This is a monumental day for Chelsea, who can now enjoy some peace knowing that critically needed medical care is forthcoming,” ACLU attorney Chase Strangio said in a statement.

The length of Manning’s hair continues to be an issue. In 2014, recommendations were made to allow her to have longer hair.

Strangio’s statement continues:

“It is nonetheless troubling that the government continues to insist that they will enforce the male hair length standards against her and subject her to a disciplinary board over administrative charges related to her suicide attempt in July, which was precipitated by the government’s refusal to adequately treat her for gender dysphoria. Given the recognition of Chelsea’s health care needs, we hope that she is immediately permitted to grow her hair consistent with the standard for female military prisoners and that all charges related to her suicide attempt and the investigation that followed are dropped.”

This is an important development, but the conversation is certainly not over. 

Photo by Michael Goldfarb/MSF

This is the burned front gate of the Doctors Without Borders/Médecins Sans Frontières (MSF) hospital in the town of Leer, South Sudan as of February 2014. The hospital was thoroughly looted, burned, ransacked, and effectively destroyed, along with most of Leer, sometime between the final days of January and early February 2014, leaving hundreds of thousands of people cut off from critical, lifesaving medical care. The hospital, opened by MSF 25 years ago, was the only secondary health care facility in Unity State, South Sudan. Hospitals have been ransacked in the towns of Bor, Malakal, Bentiu, Nasir and Leer, often during periods of heavy fighting. The damage goes far beyond the acts of violence themselves as vulnerable people are cut off from healthcare when they desperately need it.