medical guide

Coagulation cascade made simple.

Someone shared this with me on my surgery clerkship and I wanted to pass it forward. 

1) Everything centers around the perfect 10

2) 7 is a lucky number so I keep it to myself

3) 8 and 5 are cofactors

4) 3, 4, 6 do not exist

5) When you draw it out, it looks like a gun, and your trigger finger (TF) would go by the 7. so TF (tissue factor) goes by 7

6) You use guns and trigger fingers in war, so that’s the part effected by warfarin. The other one is heparin

7) The shorter path has the test with fewer letters (PT). The longer path has the test with more letters (PTT).

The last “rule” was told to me by someone else, but it helps me every time, so I’ll include it here:

8) PET is WET (PT, extrinsic, warfarin) and [Brad] PITT is a HIT (PTT, intrinsic, heparin)

Silken Pupdate

I actually have a little extra time today, so I wanted to put out an update about my new service dog in training (SDIT) Fawkes and answer a few questions I’m sure I’ll probably get at some point! :D 

This lil pupper is Clayborn’s Africa aka “Fawkes.” My husband and I drove from Virginia to Colorado to pick him up because I love his breeder and appreciate the type of temperament she breeds for (she has bred SD prospects previously). 

I’m self-training him to mitigate the symptoms of PTSD and panic disorder with some professional guidance. He will be trained in several tasks, primarily deep pressure therapy, blocking, interrupting stereotypic/harmful behaviors, medication retrieval, and guiding me to a safe place during dissociative episodes.

Although his main job will be working as a service dog, we will also participate in conformation events and hopefully will do at least one sport (though we still haven’t figured out what sport yet!). Assuming he matures well and clears his health tests, I will breed him at some point in the future, which is a very exciting prospect as it will be my first foray into dog breeding. :D

Those who have been following my blog for a while might be wondering why I got a service dog prospect so suddenly instead of going back to school after I left my job. The short version is, I’d been considering getting a SD for the past 2 years but didn’t think I qualified as disabled until after I had a conversation with my boss about applying for disability benefits because my mental and physical health became so poor that I had to leave my job much sooner than I originally intended. I had wanted to go back to school, but ended up in a psychiatric day treatment program instead due to my anxiety and bipolar disorder being very poorly controlled. After talking with my doctors and therapist, we decided that even though it would be a bit hectic having 3 dogs and a toddler at the same time in our tiny house, I would truly benefit from having a SD and it would help me regain my independence (and sanity) better than just therapy and medication could.

I ended up choosing a Silken Windhound after spending a lot of time with my friend Katie’s Silken SDIT, Sega, who won over my entire family. The breed is the perfect size for the type of work I was looking for (big enough for DPT but not too big for our little house ha), has the sighthound on-off switch, and is very affectionate, biddable, handler-focused, and intelligent. A couple months in and I couldn’t be happier with my choice. :)

I have to give a shout-out to @silkenagentsofcsbeck@doberbutts, @why-animals-do-the-thing, and @noodle-dragon in particular for giving me great advice which has been invaluable thus far. Rachel (of @why-animals-do-the-thing) actually stayed at my house for a week to improve my training technique which was amazing, and I highly recommend her as a trainer; she’s pretty much the only reason Fawkes has good leash skills now haha! I’ll write a longer review of her training services later, but I just had to give a big thank-you to all these folks for making my dream of having a SD come true. :)

Personality disorders as memes

Because this is how I learn things

There are lots of mnemonics for remembering the clusters (which have fallen out of use anyway) but I prefer one that make sense to me because it uses the A, B and C for awkward, bratty, and cowardly

Cluster A Personality Disorders (”awkward”):




Cluster B Personality Disorders (”Bratty”):





Cluster C Personality Disorders (”Cowardly”):





while i have nothing against the other rp guide’s who tell you what epilepsy and some of them explain it great, they feel like that’s all they are doing explaining it. so here is an rp guide coming from someone who has GE for those who want to play a character with it. ( below will have what GE is, what it can feel like, how it can effect the people around you, how to roleplay a grand mal / tonic - colonic seizure, and the long term + short term effects of a seizure.

Keep reading


So I’ve noticed a bunch of medical errors in fics I read, so I decided to post this handy guide to some of the most common errors and some background on basic medical things.

ps- they are not medical treatment or first aid advice. I’m not actually a doctor. yet. but I am certified in first aid. this is just so your writing can be more realistic.

other parts can be found here


Today I taught myself about reading EKG’s and where they actually line up with things going on in the heart with regards to MIs. Basically you have 3 coronary arteries that get occluded in most MIs: Left Anterior Descending (LAD), Left CircumfleX (LCX), and Right Coronary Artery (RCA). LAD feeds the anterior heart and the septum. LCX feeds the lateral and some posterior heart. RCA feeds the right ventricle and some posterior heart, as wells as the SA node in 60% of people.

Now EKGs are confusing and complicated, but it gets easier if you remember where they measure relative to the anatomy. This little diagram helps me get started:

I’ve overlaid the heart over this in the diagram up top. Now remember, those arrows are vectors which is reflected in an EKG read by the upstrokes and downstrokes of the read. (I’m oversimplifying things, but physics makes my brain hurt, and this has worked for me so far.) Practically, what it means is that if the arrow is pointing towards the damage you get ST elevations. For example, in an inferior infarct, you get ST elevations in II, III and aVF, which point towards the inferior part of the heart.

You also have leads V1-V6 which are arranged like so:

(Image from wikipedia)

Notice their vectors point anteriorly. So an anterior infarct shows up at ST elevations in some or all of V1-V6. Meanwhile a posterior infarct will show up as ST depression in V1-V3 which point away from the posterior part of the heart.

To take it one step further you can figure out which artery is blocked. But that’s just a matter of knowing the blood supply, which is basically just what’s nearby. When I’m trying to figure it out on a test, sometimes I draw out this 5 second diagram (aka artistic masterpiece):

The Ice

Originally posted by thugshawn

Requested by anonymous: imagine where shawn gets a hockey injury?

Note: Shawn and hockey….two of my fave things that happen to go together quite nicely


It happened quickly.

Too quickly, actually. You barely had any time to register what even happened when the referee and coach yell timeout.

Shawn’s laying on the ice, body scrunched up against the side as his face shows complete and utter pain. Your heart pounds against your chest as your nerves feel like they’ve been set on fire. You knew there wasn’t much you could do for him while he was out on the ice and you weren’t allowed on; the only thing you can actually do, is pray that it’s nothing serious and he will be relieved of his pain.

You hear him yell for a second and see him pound at the ice with his gloved hand, as the medic team touches around under the mass padding.

Keep reading

Ankylosing Spondylitis

Ankylosing spondylitis is an inflammatory disorder of the axial skeleton, peripheral joints, and extraarticular structures. Over 90% of pts have HLA-B27, a protein on the surface of WBCs in the presence of infection. It is 2-5 times more common in males, and onset is typically in the 2nd or 3rd generation. 


  • Occurs at entheses (attachment points between tendon, ligament, or capsule and bone) 
  • Inflammation
  • Bone erosion
  • Syndesmophyte (spur) formation

Clinical Manifestations

  • Vague low back pain radiating to buttocks
  • Bony tenderness
  • Enthesopathy
  • Constitutional symptoms - photophobia, blurred vision
  • Extraarticular symptoms 
  • Morning stiffness

Physical Examination

  • Spinal stiffness
  • Loss of lumbar lordosis
  • Increase of thoracic kyphosis
  • Stooped posture
  • Decreased chest wall expansion
  • Schober test: detects limitation of forward flexion and hyperextension of lumbar spine


  • No direct serum marker
  • Elevated ESR, CRP, Alk. Phos
  • Radiographic: “bamboo spine”, sacroilitis, pseudowidening of SI joint, sclerosis/fusion
  • Diagnosis at early stage is important to limit irreversible deformity


  • Physical therapy - exercise is the best treatment!
  • NSAIDs
  • Anti-TNF
  • DMARDs
  • Referral to rheumatologist


  • Spondylitic heart disease
    • Aortic/mitral regurgitation
Law of Attraction

I think this life philosophy called the Law of Attraction would be beneficial to many people, especially as we almost begin the new year. 

What is the Law of Attraction? 

It is essentially the “like attracts like” mentality where positive thoughts attract positive energy while negative thoughts attract negative energy. You can manifest your dreams. 

Do I believe in it?

I do believe in it. I think a lot of change starts from the mind, and everything else in life progresses from there. Especially now in my life, I have realized a lot of negativity has attracted more negativity especially with the people around me. Also I found myself never accomplishing goals because of the negativity surrounding them. For example, me wanting to lose weight never really happened because I kept telling myself I would never be as thin as that girl and tortured myself with the obsession to look a certain way. 

How does it work? 

You can start with repetitive positive thoughts or even visually through a dream board of all you want in life (dream career, partner, family, etc.) 

Some Tips to Manifestation 

  • Focus on your goal and be very specific- Write it down even if it makes you remember it. Just make sure you see it every single day. Ask yourself the reasons why you want these specific goals.  
  • Make a gratitute list- Appreciate all the things you have, and don’t focus on the things you don’t have because in the end there will always be something that someone has over you. So don’t worry to much about others and focus on you!
  • Make a worry list- Never worry about those stressors again. Write them down as a form of closure. 
  • Meditation- This may not be for everyone but it can definitely help soothe the mind and clear it for more positive thoughts. There are a bunch of apps and YouTube videos out there that can help guide medication sessions. 
  • Pretend you have what you want- This is actually mentioned in the second video (linked below). Pretend you have it and the universe will eventually let you have it. 

These are a few Law of Attraction videos that explain the philosophy very well. 

Here’s to a new year and a new, healthy mind. 



  • me: writes a simple, general no frills reference for writers who want to make a believable hospital scene without getting into way too much detail that they may struggle to retain or understand.
  • any medical professional i may have referenced who reblogs the post: IF I MAY MAKE A CORRECTION/ADDITION *goes into excruciatingly lengthy detail about their specialty for seven paragraphs. adds a medication calculator for children. talks about the merits of traction vs open fixation. includes a reference on how to replace a heart valve. teaches writers to intubate.*

Consider: Kori learning human anatomy and medicine just to patch up her boys. They find her poring over a basic medical guide one day, and practicing stitches on a small practice doll. Neither Roy nor Jason will admit it, but (even if it’s mostly practical) it’s one of the most thoughtful things anyone has ever done for them. In return, they look up anything they can about Tamaran physiology so they can return the favor if their favorite princess ever needs it.

New class, new exam: how to organize your study schedule

Hi guys, i decided to write this post for all the students who want to organize a new study session and make a schedule for a new exam. Actually this is my personal method, and it works for me so I thought it could work for you as well :)

  • First of all: prepare all the material you’ll have to study. Books, notes etc… and make a list of all the requested arguments for the exam - professors usually make a list or a programm of the whole course. When in doubt, ask the professor.
  • Before organizing a new schedule, read everything. Literally, everything and try to cut and edit all the things you won’t need or usless stuff (it happens to me that when I have to study from a huge text book and I have also my notes I took during the lessons, I have a lot of stuff I actually don’t need)

Now that you have your own material prepared and you know what you’re talking about because you read it, you’re ready to make your schedule. 

Scheduling Tips

  • Always, ALWAYS, set a timetable. Use a planner, a journal, whatever you prefer, but don’t think that you’ll be able to do all the things without planning them first. As you complete tasks, mark them and go ahead, and if you can mark or make a list of all the things you find more difficult or complicated and spend more time later to analyze and understend them.
  • For your fist study session with a new subject, don’t even try to study/repeat all the programm in two or three days, unless it’s a very very small exam. Your first (actually, second) approach has to be: learn it in the most effective way, not in the shortest time. So, take your time and pay attention to this reading/learning part of your schedule. 
  • When you’re still learning and not repeating the subject, it may be useful to write down important things, drawing mind maps, starting orgazing your summaries and notes and post-it etc…and this is the perfect time to do it. If you try to create mind maps and summaries when you’re at two or three days from the exam, you won’t be able to use them and so it will be a waste of time! 

Everyone, I’d like to introduce Beamer!!! He is officially my service dog, partner in crime, my king. We still have 11 more days of training and bonding together at the Training Center before I get to take him home, but I love him so much already!! He’s a gorgeous golden, and will perform the following tasks for me:
- Block
- Cover
- Deep Pressure Therapy
- Anxiety Alerts
- Nightmare Arousal
- Medication Reminders
- Guiding during dissociative episodes

In addition, his presence and my need to pay attention to him will help keep my anxieties lessened, as I will have less energy to focus on myself and must instead focus on him.

I can’t believe we’re finally together and I love him with all my heart!!!!!

Urinary Tract Infections

Definition of UTI

  • Pathologic bacteria in urine
    • Asymptomatic patients: growth of > 10^5 (100,000) CFU/mL
    • Symptomatic patients: 10^2 (100) CFU/mL

Classification of UTI

  • Lower tract infections: urethritis, cystitis
  • Upper tract infections: pyelonephritis, prostatitis
  • Community-acquired
  • Nosocomial: catheter-related


  • E. coli - most common
  • Gram negative rods
  • Adenovirus - children


  • Colonization of external genetalia
  • Bacteria can ascend into the urinary tract 
  • Upper tract infection most common complication of lower tract infection
  • Hematogenous spread - S. aureus

Who gets UTIs?

  • Females > males
  • Increased incidence with sexual activity
  • Childhood: M > F

Female Patients

  • Vaginal introitus and distal urethra normally colonized by gram positive organisms
  • Female urethra more prone to gram negative infection 
    • Close to anus
    • Short length 
  • Risk factors
    • Hygiene issues
    • Sexual activity
      • Void after intercourse decreases this risk

Male Patients

  • Rare
  • > 50 years of age, BPH is main cause

Other Risk Factors

  • Pregnancy
  • Unsterile or prolonged catheterization
  • Obstruction
  • Vesicourethral reflux


  • Most common manifestation of UTI
  • Infection/inflammation of bladder
  • Most commonly E. coli, can be adenovirus
  • Clinical presentation
    • Irritative voiding 
    • Supraspubic discomfort
    • Other urinary complaints?
  • PE
    • Unremarkable
    • No CVA tenderness
  • Lab
    • Urinalysis
      • (+) LES
      • (+) Nitrites
    • Urine gram-staining
      • E. coli
      • Contamination possible
  • Acute urethral syndrome
    • “Painful voiding syndrome”
    • Dysuria with sterile culture
    • Irritants, trauma, etc.
  • Management
    • Antimicrobials
      • Short-term (< 7 days) for uncomplicated cases
      • Longer therapy (7-10 days) for DM, recurrent UTI, over 65, Men
    • Symptomatic treatment
  • Follow-up
    • Repeat urine C&S 3-5 days after antibiotics finished


  • Infection/inflammation of renal parenchyma and pelvis
  • Most commonly E. coli or Proteus sp. 
  • Presentation
    • Flank pain
    • Fever
    • Chills
    • Toxic appearance
    • CVA tenderness
  • Lab
    • Urinalysis
      • (+) LES
      • (+) Nitrites
      • WBC casts
    • Urine gram stain
      • E. coli
      • Contamination possible
    • CBC
      • Leukocytosis with left shift
  • Imaging
    • Only done in complicated cases
  • Complications
    • Sepsis/shock
    • Scarring/fibrosis
      • Chronic pyelonephritis
  • Management
    • Usually treated as outpatient
    • Empiric therapy
      • Broad-spectrum antibiotics
        • IV 
        • PO quinolone
        • No nitrofurantoin
        • Watch resistance for Augmentin and Bactrim 
      • 14+ days
        • Inpatient: 24 hours after fever resolves
        • Outpatient: 14 days
  • Follow-up
    • Repeat urine C&S 1-2 weeks after treatment completed
    • Treatment failure
      • Imaging or referral

UTIs in Pregnancy

  • Asymptomatic bacteriuria very common - treat due to risk of complications to fetus
  • Cystitis
    • No fluoroquinolones
    • Recheck urine C&S
  • Pyelonephritis
    • Hospitalization
    • Empiric IV therapy, then PO
    • No fluoroquinolones
    • Recheck urine C&S

Nosocomial UTIs

  • Foley catheters 
  • Care for UTIs not reimbursed by Medicare/Medicaid 

Recurrent Infections: more than 2-3 per year

Vesicoureteral reflux (VUR)

  • Reflux of urine from bladder into ureters/renal pelvis
  • Common cause of UTI in children
  • Renal scarring due to volume and duration of reflux
  • Presentation
    • Weight loss
    • Nocturnal enuresis
    • Failure to thrive
  • Labs
    • Urinalysis
      • (+) LES
      • (+) Nitrites
    • Urine gram stain
      • E. coli
    • Cast formation
  • Imaging
    • Voiding cystourethrogram (VCUG)
    • Management of VUR
      • Mild
        • Spontaneous resolution usually
        • Antibiotics until puberty
      • Severe
        • Surgical intervention
        • Antibiotics into condition corrected