ng tubes

I wrote an order for 120ml of McDonald’s Cold Brew coffee PRN through his NG tube, but not before 1400. It’s the best order I’ve ever written. Some people don’t like it, but hey, I’m not going to be the one denying a dying man his daily coffee.
—  R3
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I have my second dose of my newest treatment, Stelara, coming up, and it’s left me feeling quite powerless.

Because of this, I decided to choose something medical that I had control over and do it and explain it to people to sort of liberate myself from the helplessness that I’m feeling.

So with that said… WHAT’S ON YOUR FACE!

Reblog if you want to raise awareness about NG tubes and Crohn’s Disease in general!

youtube

TUTORIAL TUESDAY

A demonstration of how to insert and check placement on an NG tube. (Narrated by a dude with a British accent).

anonymous asked:

Because of magic, my MC is stuck in a dream and can’t be woken for a period of three days. She spends that time in a hospital—would they be likely to insert breathing tube/feeding tube/etc? How quickly after admitting her? If there’s nothing medically wrong with her, any aggressive things they could try to wake her up? Any likely problems she’d have from being asleep so long?

Hey there nonny. This character is going to get heavily medicalized, and fast. 

Unconsciousness with no obvious cause is a bad thing, and your character is going to wake up in the ICU. She’ll likely have a feeding tube in her nose (NG tube), at least two IVs (even if nothing is running but saline), and a breathing tube and a ventilator, even if she’s breathing fine on her own. 

In this case, she’s been intubated for airway protection, not for respiratory support. But what we get scared of in medicine is that she’ll vomit and aspirate (inhale the vomitus). A breathing tube will help with that. 

She’ll also most likely have a Foley catheter in place (a tube that goes into her urethra to drain her bladder). This isn’t just a way to keep her clean, it also helps monitor her urine output (which in turn monitors her kidneys and her overall perfusion). 

As for how quickly: probably intubated in the ER (if not the field), IVs in the ER, feeding tube and Foley might be once she’s upstairs a few hours after arriving at the hospital. In terms of waking her up, she’d likely be shaken, have her name spoken very loudly, and someone might do a sternal rub or press a pen across her nail bed to try to wake her up. (These are… important, and necessary, but maybe not legal depending on location. I find pen+nail bed works better.) 

She’ll also have gotten CT scans and possibly MRIs. 

Hope this helps! 

xoxo, Aunt Scripty

(Samantha Keel)

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Reflections on Surgery

I went into surgery scared.  I heard rumors of crazy schedules, apathetic residents, confusing pimp sessions in the OR when you just don’t know what to say, and people cursing and yelling more than what’s considered to be normal.  Well, all of things happened.  I was at the hospital from 430am-630pm EVERY DAY. On weekends, it was only 5am-noon.  I never worked so hard in my life, but the work was different than I expected.  I had to work hard to be heard by residents and actually contribute to the team.  I had to really come up with good ways to be involved in patient care.  My goal everyday was to do one thing that was actually helpful for a patient, not just helpful for my education.  When I scrubbed out of my last surgery, an emergent abdominal bleed due to a mets carcinoid tumor coming from the ED, I actually felt sad.  I didnt want to go.  I had been so busy, but I could sense I really loved surgery.  But as I walked out on my last day feeling genuinely depressed it was over, I was certain I had loved it.  Surgery is probably the most difficult rotations because of the exhaustion compounded onto a fast schedule.  I barely had time to catch up with my own thoughts during the rotation, and it was only over this last weekend I realized what I thought about it and how to do well (I got my evaluations this weekend and I was told by an attending I was the “best medical student he’s ever worked with.  I thought it was a prank, but apparently not!).  

How to Succeed on Surgery Rotations:

Keep reading

Third year reflections

I’m officially in my last year of medical school - I can’t believe how quickly time has flown.

Third year was an emotional time for me. It had some of the highest highs and the lowest lows so far. A list of the best and worst moments from each rotation:

  • Psychiatry
    •  Best: A patient wrote a poem about his struggles between darkness & light, and gave me a copy (which is still on my wall).
    • Worst: Realizing that my own mental health problems weren’t going anywhere.
  • Neurology
    • Best: Doing a full H&P & presenting to an attending on my own for the first time.
    • Worst: Watching an attending I admired ignore the visibly overwhelmed and upset parent of a patient, without being able to do anything myself.
  • Pediatrics
    • Best: Learning the newborn exam, and actually auscultating a murmur on a baby.
    • Worst: Learning that the lab lost a precious sample of CSF from a tiny premature baby who was seizing - and lied about it - despite my calling every day for a week.
  • Ob/gyn
    • Best: Being trusted enough by my senior to be sent to the peds ED to do an H&P on my own; once there, being recognized by both the ED attending & peds resident, both of whom told me to do my interview and let them know what I found, since they trusted me to get the info they needed too.
    • Worst: Being yelled at for not knowing how a clinic worked on my first day there. Also having to call residents Dr. __ for literally the only time all year. Also having to stay 2 hours for morning conference after doing overnights. 
  • Surgery
    • Best: That moment, for the first time all year, when I finally started to feel competent - I knew my patients, I was in charge of their care, they knew me & trusted me, and my team trusted me too.
    • Worst: I don’t even know where to begin. Having things thrown at me in the OR. Being awake & in the hospital for 34 of 36 straight hours. Getting yelled at by 6 nurses at once for doing what the attending asked me to do in the middle of a code. Seeing my first patient die. Seeing my second patient die. After both deaths, having no acknowledgement of what happened, and just being told to get back to updating the lab lists. The overwhelmingly prevalent sentiment that your worth as a human being is dependent solely on your position in the hierarchy.
  • Medicine
    • Best: My attending calling me the best intern he’d ever had. My patient having her husband bake bread & bring me a loaf.
    • Worst: Having one of my patients transferred to the ICU and not going to see him before he died - something I regret, and won’t ever let happen again. 

I’ve learned a lot. I know how to manage COPD and CHF and asthma. I know how to draw blood and do ABGs and place NG tubes. I know the names of maybe a third of the residents and a third of the nurses, and I’m working on learning more. I know how to talk to patients from all walks of life and take care of them at their most vulnerable. I have plenty more to learn, but for now - that’s enough.

Fun with Dr. K...

_______________________________________________________________________

(Dr. K at work, sick with a cold, being a ginormous baby)

Me: If you look at the green stuff pouring out of my patient’s NG tube into the canister, you can have a Kale, super food smoothie to make you feel better.

Dr. K- I cannot with you. (Turns and leaves)

_______________________________________________________________________

(When I’m charge mass chaos always ensues.)

Dr. K - Good night. At least you didn’t let the unit burn down today.

Me- Good times. Hey, let’s do it again some day.

Dr. K- NO- Never again!

_______________________________________________________________________

Me : My patient is confused, rebuking me in the name of Jesus.

Dr. K: That doesn’t sound confused. I rebuke you in the name of Jesus every day.

_______________________________________________________________________

FriendNurse: My patient has a critical sodium of 165.

Me: So he’s almost as salty as you, Dr. K.

Dr: K- I resent that, I am much saltier.

_______________________________________________________________________

TV news airing story about a woman impersonating a doctor and performing procedures and writing prescriptions for months in another hospital in a sedated patient’s room.

Me: Hey, are you running that same scam here?

Dr. K: (laughs) I’ll get you back for that one.

Chest X-Rays (CXR) Interpretation

DRSABCD is a familiar acronym for those who have undertaken First Aid/Basic Life Support courses. Now DRSABCDE can used as a simple, yet comprehensive, approach to CXR interpretation.

Normal CXR 

D – Details: 

  • Patient name, age / DOB, sex
  • Type of film – PA or AP, erect or supine, correct L/R marker, inspiratory/expiratory series
  • Date and time of study

R – RIPE (assessing the image quality)

  • Rotation – medial clavicle ends equidistant from spinous process
  • Inspiration – 5-6 anterior ribs in MCL or 8-10 posterior ribs above diaphragm, poor inspiration?, hyperexpanded?
  • Picture – straight vs oblique, entire lung fields, scapulae outside lung fields, angulation (ie ’tilt’ in vertical plane)
  • Exposure (Penetration) – IV disc spaces, spinous processes to ~T4, L) hemidiaphragm visible through cardiac shadow.

S – Soft tissues and bones (it is common to leave it until the end)

  • Ribs, sternum, spine, clavicles – symmetry, fractures, dislocations, lytic lesions, density
  • Soft tissues – looking for symmetry, swelling, loss of tissue planes, subcutaneous air, masses
  • Breast shadows
  • Calcification – great vessels, carotids

A – Airway & mediastinum

  • Trachea – central or slightly to right lung as crosses aortic arch
  • Paratracheal/mediastinal masses or adenopathy
  • Carina & RMB/LMB
  • Mediastinal width <8cm on PA film
  • Aortic knob
  • Hilum – T6-7 IV disc level, left hilum is usually higher (2cm) and squarer than the V-shaped right hilum.
  • Check vessels, calcification.

B – Breathing

  • Lung fields
  • Pleura: reflections, thickenning
  • Vascularity – to ~2cm of pleural surface (~3cm in apices), vessels in bases > apices
  • Pneumothorax – don’t forget apices
  • Lung field outlines – abnormal opacity/lucency, atelectasis, collapse, consolidation, bullae
  • Horizontal fissure on Right Lung
  • Pulmonary infiltrates – interstitial vs alveolar pattern
  • Coin lesions
  • Cavitary lesions

C – Circulation

  • Heart position –⅔ to left, ⅓ to right
  • Heart size – measure cardiothoracic ratio on PA film (normal <0.5)
  • Heart borders – R) border is R) atrium, L) border is L) ventricle & atrium
  • Heart shape
  • Aortic stripe

D – Diaphragm

  • Hemidiaphragm levels – Right Lung higher than Left Lung (~2.5cm / 1 intercostal space)
  • Diaphragm shape/contour
  • Cardiophrenic and costophrenic angles – clear and sharp
  • Gastric bubble / colonic air
  • Subdiaphragmatic air (pneumoperitoneum)

E – Extras

  • CVP line, NG tube, PA catheters, ECG electrodes, etc

More medical content here!