t******9
发帖数: 270 | 1 企图记住口诀，但是从口诀首字母转换成相应的内容总要想半天。而不写下来真的很容
易忘。我想在考试开始之前把所有常用项目写下来，做题的时候对照一下有没有漏。不
知道到时候有没有这个时间和办法写。有纸或者board吗？不知道下面的列表有没有什
么需要加的，请考过的朋友帮忙。谢谢！
Monitor组；
IV access
pulse ox
oxygen
cardiac monitor
bp monitor
三大常规组：
cbc
bmp
mag
pt/inr
ptt
blood type and ab screening
type and cross
blood culture
tsh
lipid profile
beta-hcg
LFT
amylase
lipase
trop
cpk
FSBS
ua
urine culture
stool culture
检查组：
ekg
FEV1
PEFR
chest x-ray
u/s
KUB
ct
echo
eeg
mri
对症处理组：
meds for nausea
for fever
for pain
入院常规：
npo
bed rest
stock... 阅读全帖 |
|
e****0
发帖数: 678 | 2 翻翻我的箱子底， 找到我自己临考前的单子。
•Pregnancy
CBC/BMP
Blood type and Rh
Atypical antibodies/rubella AB
UAUCX
HIV/RPR/HBSag
Chlamydia/pap smear
•All disease
Diet
Exercise
Consult/counseling/consent/vaccine/screening/monitoring
PT/OT
•Acute R distress
Oxygen
ABG
Chest X ray
Pulse oximetry q 1hour
•COPD/asthma PEFR+Elevated head of bed
•All arthritis
Synovial fluid
•All office cases
CBC/BMP, PT/PTT, UA/UCX, FOBT, LIPD/LFT, ESR/TSH, EKG/Glucometer/CXR
•Surgery
NPO/bedres... 阅读全帖 |
|
e****0
发帖数: 678 | 3 • Exaggerated deep tendon reflexes can be seen in lock in syndrome.
• Non bleeding varices are managed with nonselective beta-
adrenergic antagonists, such as propranolol.
• Sclerotherapy, endoscopic band ligation, and surgery are
indicated after a patient has a first episode of variceal bleeding.
• TIPS is a last resort in variceal bleeding unresponsive to
medical and endoscopic intervention.
• Ischemic colitis
CT—thickening of eth bowel ... 阅读全帖 |
|
b******a
发帖数: 704 | 4 Match完毕，整理心情的时刻， 重提经典好帖。 在麦地时间不长，这些几年前的文章
对我就像新的一样。对内科来说，无论Match上了也好，需要重装上阵也好，有了实际
工作经验，才更能感觉到这些经验，字字珠玑。
能够Match上，能够生存，或者做得更好，不仅仅需要Medical Knowledge，
还要有作者那样的学习能力，效率，总结能力和情商。
“Medicine is a science of uncertainty and an art of probability.”
如果Match上了，可以思考对IM intern工作的要求，理解了吗，准备好了吗？
需要准备Match的同学，该如何提高，如何能够让PD们看到自己充分准备好了，有能力
达到称职的Intern的水平？ 例如Communication，怎样才能达到很好和不同的病人
，家属，护士和组内成员的交流？
如果连一个帖子也不敢自己发，或者一个观点也不能阐述，如何能够达到交流的目的？
如果不是天生的，这些能力不是一天就能培养出来的。Match本身，就是一个训练，提
高，筛选的过程。
如果需要重新Match，对比想想那里需要加强提... 阅读全帖 |
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f*******l
发帖数: 606 | 5 Warfarin is blocking the synthesis of VitK dependent clotting factors. Used
to prevent deep venous thrombosis. It takes few days to demonstrate effect.
When Pt has acute chest syndrome, aspirin and heparin are used to stop the
further development of preexisting clots. |
|
j******1
发帖数: 138 | 6 Wafarin从不用于CAD,只用于DVT和pulmonary embolus. Aspirin用于acute coronary
syndrome,而且是第一时间，Heparin在进行PCI的1时候使用而且是暂时的。 |
|
z**********4
发帖数: 467 | 7 It seems like complications of chronic DVT(deep venous thrombus) from
immbolization.
First, get U/S to have a general idea of the extent of thrombus.
The most fearful complication is PE where patient dieS quickly. IVC filter
will be needed if he does not repond to heparin(Probably not since it seems
more chronic to me). |
|
b*****g
发帖数: 53 | 8 特别特别感谢热心的victor和jenny！受益匪浅！
很抱歉以下notes,中英文混杂。
HOW TO SURVIVE IN YOUR INTERN YEAR (BY VICTOR)
1. Familiar with EMR
• Intern’s responsibility and daily work
1. inpt floor: when you enter, check your pts, follow up with lab results
(trend), VS, medication, overnight changes, progress notes(overnight and
morning symptom, PE, lab trend, meds list, assessment and plan, 会诊意见计划
)。During round, report it to senior and attending. Assessment &Plan will be
for yours. 45min for 1pt, intern can... 阅读全帖 |
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d******g
发帖数: 258 | 9 How to manage step3 CCS?
It’s hard in the beginning, kind of clueless for me. But you will be able
to get the idea pretty quickly after 5-6 cases in computer. Here’s my
thoughts how to manage it quickly and try not to miss things.
1. Differential if need urgent care.
All Chest pain, SOB, AMS, post-trauma, little infant all need to be ordered
with ER order before physical exam.
ER order mnemonic will be POC IV, ( have to poke someone for IV line)
Pulse oxygen
Oxygen
Cardiac monitor and BP mon... 阅读全帖 |
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n***j
发帖数: 184 | 10 This one was in January,half way thru intern year.
一个同事病倒了，不晓得什么时候才能回来。
有人生病，就有人顶班。就这么多人，健在的人只能硬抗。这里有类似于国内的备班，
有人临时生病，备班的得一个小时内到医院，一般是备10天。因为她生病少了个人，我
得连续备20天。如果她一直病着，余下人的假期、周末和自选轮转都会受到影响。住院
总倒是很稳，因为他只告诉我们：“凡事要以大局为重。” 这时就感觉，虽然每天我
们是呆逼，但是好比航空母舰也要有扫厕所的一样，intern还是有价值的。说到排班，
还是和国内有不同的。第一天就知道整年的排班，哪个小时该去哪里，写得清清楚楚。
至于哪个小时能回家，那是另一码事。(The girl actually quit later because of
health issue. There have always been interns leaving the program every year
for various reasons. Last year, one intern ditched the ... 阅读全帖 |
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n***j
发帖数: 184 | 11 Night float today is boring. R3 just told me that I could do a central line.
I was very excited and consented the patient. Then, she told me that the
patient was on heparin, perhaps it would be better if an R2 did this. I
smelled "Yes, no problem" and said " F*** " in my mind.
Anyway, next session of the intern story. I wrote this one a couple of weeks
ago and some of it was about my thought on the debate about the "multiple
myeloma patient from Hangzhou saw US doctors."
一转眼已经5月，新的一批intern已经在问... 阅读全帖 |
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d******d
发帖数: 121 | 12 以前有前辈写过在Queens的体验，我学习到很多。昨天在ACAP听到大家对如何在
NYHQ做OB还有一些问题，所以希望写下自己的经历，对后来人有所帮助。
首先非常感谢ACAP的帮助，让我们在NYHQ能一直有机会。我来到NYHQ医院做了一个
月的OB. 虽然知道这个机会来之不易而且还有很多XDJM在报名排队，我在来之前还是有
些犹豫。因为可以在我所在的城市里的教学医院做OB，为什么要离开家人和工作，来到
一个社区医院做呢？其实来到第一天的见闻就打消了我所有的顾虑，一个月确实挺值的
，只是没有机会再做长一些时间。
NYHQ位于法拉盛区（Flushing），医院大厅标注着英文、中文、韩文、俄文等等，
足可以看出医院的多元化（diversity）。第一天先参加orientation和infectious
control training， 然后去街对面GME办公室递交application form等paperwork，再
回到医院办理ID卡，到五楼找chief resident报道。一批observer一般有四人， 两周
在CCU或MICU，两周在内科Floor。稍有... 阅读全帖 |
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d******u
发帖数: 47 | 13 1, Your patient is a gravida 2 para 2 female with a complaint of a vaginal
discharge, vulvar irritation, and dysuria. Her symptoms have recurred 4
times within the past year. She had a recent urinary tract infection that
was treated with ciprofloxacin, but is in otherwise good health. She is
afebrile with normal vital signs, and pelvic examination reveals vulvar and
vaginal erythema with a thick white discharge in the vaginal vault. KOH prep
reveals pseudo hyphae. Which of the following treatmen... 阅读全帖 |
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r********z
发帖数: 20 | 14 别怕，别怕。这种事多了去，下次小心就是了。我学到最关键的就是临下班之前要最后
好好把工作检查一遍。保证每个病人都是干干净净的。该给的药都给了，该干的事情尽
量别留给下面一个班的人干。最后的检查至关重要啊。我有一次就忘了把病人的
heparin打开了。后来自己发现了。 |
|
g****i
发帖数: 2269 | 15 昨天上班一个病人，after heart cath, 80% left main blockage, 90% prox circ
blockage， 需要开胸手术，回到floor后，cardiologist就把病人转给surgeon了，自
己完全退出了，一般情况下cardiologist还应该是attending,只有做完手术后
attending 会变成surgeon，cardiologist变成consult。而且这个cardiologist也没有
order any home meds，surgeon的PA看了病人，解释了一下手术并写了４行主诉，４行
plan就消失了。可怜我晚上７点开始page oncall PA, 高速她病人的情况，vital
signs， surgical plan, home meds and details of cath. Then most home meds
were resumed and heparin gtt would be started 6 hours post shealth removal.
有时觉得病人挺可怜的，得个这么大的病，到 |
|
l****n
发帖数: 272 | 16 IV PUMP弄明白了很简单，主要是那些DRIP的SETTING。因为PUMP里有已经PROGRAM，对
于有些要像HEPARIN， LEVOPHED， DOPAMING DIPRIVAN等等都有，所以要会用，搞清楚
CONCENTRTION，体重，要给的剂量等就行了。
还有一个很常用的作用就是调节RESISTANCE，有些IV SITE你FLUSH是好的但是有很大阻
力，那么可以上调RESISTANCE。不过要小心不要BLOW了VEIN。 |
|
l**********t
发帖数: 1212 | 17 谢谢讲解， 什么是drip setting? 是 xx ml/h 吗？我们班上有个老奶奶可逗了， 150
ml over 1.5 hour 需要用笔算 ml/h。我就和她说， 别算了， 100ml/h。
你说的是heparin 要记算体重，计量吧。
怎么上调resistance啊， 老师说push 时如果有阻力， 就pull to release the clog
and then push 2ml NS into iv to flush. |
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a********n
发帖数: 438 | 18 说说TELE FLOOR吧
在tele/PCU 工作了2，3年，拿了PCCN和CMC，说说我所在医院的tele floor ，给tele
的新人一点点我的经验教训：）
首先是tele的病例：CHF，pre/post cardiac cath pt, various arryhythmia on
various drips, CVA/TIA,respiration distress on Bi-pap/CPAP, stable
ventilated pt with trach.Packmaker insertion. acute renal failure, chest
tube/PCA PUMP， CAPD啥的就不说了，M/S也都有。还有各种各样M/S处理不了，ICU又
不要的病人 ：）
1最需要掌握的是基本EKG STRIP的辨认和处理。这个ACLS已经覆盖了一些皮毛。
2还有基本DRIP的知识，常用到的DRIP有Diltiazem gtt, amiodarone gtt, Heparin
gtt, Dopamine, Dobutamine,Neseritide Nitroglyci |
|
a********n
发帖数: 438 | 19 Atrial Fibrillation
这个是最常见的arrhthymia 啦。如果SYMPTOMATIC/UNSTABLE，那么需要Electrical
CARDIOVERT
如果病人血压正常，没有心悸，relatively asymptomatic, 那么有3点注意：
1>Control ventricular responsive rate , 常用药有calcium channel blocker: IV
diltiazem BOLUS followed by continous IV 5-10mg/hr. 超过15mg/hr 需要转送ICU
。注意血压。beta-blocker:IV metoprolol 5-10mg IV then q6hrly. 我这儿有个医
生特喜欢用SOTALOL。 IV DIGOXIN : 0.5mg IV x1, then in 6hrs 0.25mg IV q6hrx2
then standing dose 0.125mg -0.25mg in am.
2>ANTICOAGULATE，会上HEPARIN DRIP（check PTT q6hr |
|
|
b*****o
发帖数: 6080 | 21 嗯，承蒙教诲。多谢！
PMH
will
heparin
such |
|
g****i
发帖数: 2269 | 22 good job, I need to learn a lot from you. Sometimes, I am too
straightforward and people around me feel I gave them a hard time. It is all
about communication skills.
PMH
will
heparin
such |
|
m*****h
发帖数: 2638 | 23 dressing change: 每7天一次 and prn if dislodged， also change the lock。
那个biopatch， blue to the sky，（不过这个东西有新产品出来了，不在有单独的
biopatch，而是在那个dressing 上面自带的一种jelly样的东西）stat lock，然后
transparent dressing。严格无菌操作，护士带口罩，病人头偏向另一边或者带口罩。
flush： 10ml NS every 8hrs，有的地方用heparin 10units lock，也是every 8hrs
blood draw： 先flush10ml NS，然后回抽，扔掉10ml血，再收集标本，最后再flush
20ml。
每次要用picc时，那个hub要用酒精patch 用力的rub 20 seconds。
remove picc：每个picc 放进去的时候都有个记载，放了几个cm进去了，外面留了几个
cm，总长度几个cm，tip是不是trim 过。这个在病人的chart里头有，或者有的floor有
一个单独的folder... 阅读全帖 |
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p*****n
发帖数: 3678 | 24 最近在一个 medical & rehab hospital 找到了工作， 还是比较激动的， ADN 后在
NH 干了两三年.
interview 时那个 DON 说她们做 Blood transfusion, heparin lock, 还有呼吸机，
一个护士只照顾 7 个病人，她们 不做 rehab, rehab 都转到别的 rehab place 去做
。说得我很糊涂. 因为这个 hospital 就叫 rehab hospital 啊？ 我以前在的小的 NH
也有一个 subacute unit, 从来没有上面的那些，而且一个护士要照顾 20 多个病人。
这么说是不是这个 hospital 和别的 acute-care hospital 差不多了？我的目标还是
希望以后去一个 acute care 的 hospital, med-surg/ER/ICU 之类的unit, 希望这段
工作经历对以后有帮助。 |
|
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C**********4
发帖数: 454 | 26 什么是正压帽？肝素冒？美国一般叫SALINE LOCK，我记得以前在国内上班的时候有叫
做肝素冒的东西，美国这边不用肝素冒，一般都是每个SHIFT FLUSH SALINE LOCK 1-2
TIMES，直接拧到IV Catheter上的。我发的这个图就是蓝色的头就是SALINE LOCK了,白
色的连接到IV catheter,有IV FLUID的时候就是用蓝色的这个头接IV,FLUSH的时候也是
用这个头接SALINE FLUSH。 |
|
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h******o
发帖数: 641 | 28 多谢回答，正压帽是positive pressure cap,
2 |
|
j**********t
发帖数: 3480 | 29 你是说central line用的东西么？这些都有啊。 |
|
F*******6
发帖数: 17 | 30 记得去年九月份我在家附近找到工作并在上班之前发表了一篇题为《希望不要与菲佣
们打交道》的文章，当初说好说坏的都有，所以我就把帖子给删了，但是命运恰恰跟我
开了一个玩笑，我上班的preceptor就是个菲律宾老巫婆！而且我所在的科室有十几个
菲律宾人，我不知道哪里踩了她们的尾巴，碰上我从来都是绷着个脸，跟她们打招呼理
都不理（当然有几个菲律宾人看起来还是比较nice的），好的，长话短说，还是说说我
的preceptor----那可恶的老巫婆吧！
我以前上班的医院是一个很正规的医院，听完交班后，护士一定要到病房去评估病人，
六个病人至少花上一个小时有时要一个半小时。而这家医院护士听完交班后只是到病房
介绍一下自己的名字然后把名字写在黑板上就完事，前后加起来不用5分钟就完成了，
做paper work时都是照葫芦画瓢按照前一班记录的打钩，病人进院时水肿+++，用了
lasix后到出院还是+++，我是不能改的，还厚颜无耻的说你现在follow 我就得听我的
，等你自己上班了你怎么做都行！不过话就说回来这家医院确实是烂，护士也是极度的
不负责任的，有一次一个白人护士的病人@2300血压是78... 阅读全帖 |
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L******r
发帖数: 522 | 31 现在批准的主要是Heparin类， 目前市场最好的是Enoxaparin，其余的也就PPS还可以
。 感觉前景不大，还是recombinat hormone, monoclonal antibody这些peptide和
protein类的比较有前景。 |
|
g********n
发帖数: 4054 | 32 来自主题: Pharmaceutical版 - 请教一句英文 I guess you shall ask 医版.
参http://en.wikipedia.org/wiki/Central_venous_catheter
"The catheter is usually held in place by a suture or staple and an
occlusive dressing. Regular flushing with saline or a heparin-containing
solution keeps the line patent and prevents thrombosis (formation of a blood
clot)."
我觉得here Patent = visible (accessible?) |
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N**********d
发帖数: 2466 | 33 baxter and other companies put the heparin on the market, right?
so they should take the full responsibility. |
|
l******k
发帖数: 27533 | 34 你这是干嘛？
做research还是帮家人问疗法？
抛砖引玉，我没时间仔细查了
印象中是nitroglycerin/isosorbide and calcium channel blocker，beta blocker
来治疗coronary disease
NO是主要作用途径之一，是上面前两个药的代谢物，主要是vosadilation,扩张
coronary血管,让更多的血液能流入深层的心肌细胞，防止心肌缺血。。。
至于clots，严重的要手术，不手术用aspirin, clopidogrel, warfarin, heparin...
如果是MI，那有紧急破血块的药，不过要在一定时间内用才有效 |
|
l******k
发帖数: 27533 | 35 good question!
acute setting还是用drip 比较多，为了可能的procedure准备吧
Xarelto是个很好的选择，从heparin convert不需要bridge，应该onset of action很快
surgical |
|
l******k
发帖数: 27533 | 36 good question!
acute setting还是用drip 比较多，为了可能的procedure准备吧
Xarelto是个很好的选择，从heparin convert不需要bridge，应该onset of action很快
surgical |
|
j******e
发帖数: 50 | 37 I don't know if coumadin is more efficacious than heparin or not, but I don'
t think so. They work differently and are used for different indications
We don't want patients to stay away from spinach or green leafy vegetable,
we just want them to be consistent.that being said, if they have been eating
green leafy vegetable everyday, we want them to keep doing it.
I actually hate when patients tell me that they are not allowed to eat green
leafy vegetables anymore. This is a myth.
You can still ta... 阅读全帖 |
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u*******s
发帖数: 688 | 38 Type 2 HIT is the deal breaker here. He cannot be discharged. 50% drop of
plt from baseline on 10/25. D/C heparin and UFH if used for flushing
catheters. Initiate argatroban 2 mcg/kg/min. I'm not sure how hospitals
would dose this drug over what long of a period. Monitor aPTT. Argatroban
can increase INR so when pt is restarting warfarin after plt is stable, this
is something to watch out for. Hgb low, consider pRBC.
Clindamycin 300 mg qid should be D/Ced because no benefit for post-op
prophylax... 阅读全帖 |
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s**********8
发帖数: 25265 | 39 来自主题: MedicalDevice版 - stent http://en.wikipedia.org/wiki/Stent
Stent
From Wikipedia, the free encyclopedia
For people named Stent, see Stent (surname).
Stent
Intervention
MeSH
D015607
In the technical vocabulary of medicine, a stent is an artificial 'tube'
inserted into a natural passage/conduit in the body to prevent, or
counteract, a disease-induced, localized flow constriction. The term may
also refer to a tube used to temporarily hold such a natural conduit open to
allow access for surgery.
Contents
[hide] 1 Etymology
... 阅读全帖 |
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A*******s
发帖数: 9638 | 40 Risks over benefits.
You are absolutely right. We need to take care of the critical issues first
. In her case, after stroke happened , I had to prevent her from recurrent
stroke first and took the chance of epistaxia.
I believe she had internal bleeding other than epistaxia after being on
Pradaxa.
But just being off heparin several hours for endoscopy, she had another
stroke.
I am helpless.
I
then, |
|
A*******s
发帖数: 9638 | 41 Age, female. That's it. She was pretty healthy until the A-fib.
No coagulopathy and TTE was neg. No TEE since she would be on Pradaxa
anyway.
She understood the risks prior to be on anticoagulations including heparin. |
|
A*******s
发帖数: 9638 | 42 In her case, for the first stroke, no heparin, sure.
But for the second stroke, I have no other choices. She was not a TPA
candidate.
Again, risks over benefits.
The patient and family should always be informed prior to the initiation of
anticoagulation.
make |
|
A*******s
发帖数: 9638 | 43 No heparin for any strokes. For a-fib, it depends.
hemorrhagic |
|
y******a
发帖数: 590 | 44 I probably didn't ask the questions in a clear way. My question is, if pt
does have a condition require anticoagulation, when would you start it after
the stroke? for example, if a pt came in with a massive MCA ischemic
stroke, and a newly identified a fib, when is the appropriate time to give
heparin/coumadin, considering the risk of hemarrhagic conversion? and will
you give both aspirin and plavix for anti platelet agent or only one of them
? I am not a neurologist, but my experience with ... 阅读全帖 |
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A*******s
发帖数: 9638 | 45 Risks over benefits.
You are absolutely right. We need to take care of the critical issues first
. In her case, after stroke happened , I had to prevent her from recurrent
stroke first and took the chance of epistaxia.
I believe she had internal bleeding other than epistaxia after being on
Pradaxa.
But just being off heparin several hours for endoscopy, she had another
stroke.
I am helpless.
I
then, |
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A*******s
发帖数: 9638 | 46 Age, female. That's it. She was pretty healthy until the A-fib.
No coagulopathy and TTE was neg. No TEE since she would be on Pradaxa
anyway.
She understood the risks prior to be on anticoagulations including heparin. |
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A*******s
发帖数: 9638 | 47 In her case, for the first stroke, no heparin, sure.
But for the second stroke, I have no other choices. She was not a TPA
candidate.
Again, risks over benefits.
The patient and family should always be informed prior to the initiation of
anticoagulation.
make |
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A*******s
发帖数: 9638 | 48 No heparin for any strokes. For a-fib, it depends.
hemorrhagic |
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y******a
发帖数: 590 | 49 I probably didn't ask the questions in a clear way. My question is, if pt
does have a condition require anticoagulation, when would you start it after
the stroke? for example, if a pt came in with a massive MCA ischemic
stroke, and a newly identified a fib, when is the appropriate time to give
heparin/coumadin, considering the risk of hemarrhagic conversion? and will
you give both aspirin and plavix for anti platelet agent or only one of them
? I am not a neurologist, but my experience with ... 阅读全帖 |
|
A*******s
发帖数: 9638 | 50 来自主题: Medicalpractice版 - a case 这个case的最重要一点是pain。 我开始想到了carotid dissection， 但应该引起对侧
的偏瘫。 一般stroke是没有pain的， 当然有些posterior fossa的stroke可能会引起
headache。
ascending aortic dissection可以引起ischemic neuropathy。 我想病人的症状是
brachial plexus ischemia。 如果没有gut给TPA， heparin是必须的。
What was your followup，宝宝？ |
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