A common mistake - the ETT was 24cm at the lip. I heard diminished breath sounds on the left, we pulled it back and taped it. After the CXR came back, we rechecked - it was 28cm at the lip. No wonder the vent was alarming high pressures.
Here are a few mnemonics I picked up that helped me out...
HAD CLOTS: PERC Rule - Risk factors for PE
Leg Swelling - Unilateral
O2 Sat < 95%
Surgery/Trauma History - Recent
AMPLE: Important history items in trauma patients
Past Medical/Surgical History
Last Meal/Last Menstrual Period
PHAILS: Toxins that cannot be decontaminated with charcoal
DUMB BELSS: Cholinergic Toxidrome
ME DIE: Differentials for Osmolar Gap
Diuretics (Mannitol, Sorbitol)
MUDPILES: Differentials for Anion Gap Acidosis
Ethanol, Ethylene Glycol
Salicylates, Starvation, Solvents
AEIOU: Indications for dialysis
I STUMBLED: Toxins that can be removed by hemodialysis
AEIOU TIPS: Differentials for Altered Mental Status
Toxins, Trauma, Tumor
Stroke, Seizure, Shock
The three-digit COMLEX score is often difficult to interpret. This table converts your score to a percentile so you can gauge your performance against that of your peers. This table is based upon the 1995 to present three-digit score with a mean of 500 and a standard deviation of 83. Passing score is 400.
Here's another percentile table - this time for the COMLEX I. They list the mean as 500, the SD as 79, and the SEM as 18-25.
Here's a little table to help you interpret your USMLE scores. The scores reported are hard to decipher, and it sometimes helps to think of your score in terms of percentiles to see how you performed relative to your peers. This table is based on the most recent administration of the test in which the mean was 218 and the standard deviation was 23 for first-time test takers in the US and Canada. A score of 185 is passing. Keep in mind that the SEM for this measure was 6 points, so you should think of your percentile as a range. For example, someone who scored a 210 should add 6 and subtract 6 to look at the percentiles between 204 and 216. This gives us a range of 27th to 45th percentile.
|USMLE 3-digit score||Percentile|
Lara was having some shoulder pain for a few weeks, and it wasn't going away. I took her to see a doctor at the clinic, and she also had a few visits with a doc at school that did some manipulation, but she was still hurting. We went back to the clinic for some injections, and got some xrays. When the radiologist's report came back, there were some abnormal findings, so we ended up getting an MRI. Lara has a few disks that are herniated dorsally (the arrows on the right). Lots of people get these, and although it looks bad - it's usually no big deal. Same thing with the Chiari Malformation (left arrow). This is where the cerebellar tonsil protrudes through the foramen magnum at the base of the skull into the spinal canal. Also not a huge deal. The problem seems to be a combination of a reversal of the normal lordosis (the spine should have a natural backwards curve), and also a slight narrowing of the disk heights. She also has some mild osteophytes (bone spurs). All of these things are leading to a narrowing of the foramen that the nerve roots pass through as they exit the spinal canal. C5 and C6 serve the back of the shoulder and also go into the brachial plexus - eventually leading to the median and radial nerve. This is causing her some pretty intense pain and muscle spasms in her shoulder, as well as some tingling sensations down her arm. Right now her doctor is recommending some conservative treatment including physical therapy and accupuncture. We're really hoping that she will be able to avoid surgery. Keep her in your thoughts and prayers.
Biomedical Ethics has always intrigued me. This groundbreaking case has shocked and amazed me. When I mentioned it to one of my professors, he exclaimed: "THIS HAPPENED IN AMERICA?"
Ashley is a 9 year old girl with static encephalopathy, an idiopathic condition that renders her permananently disabled. Her doctors removed her breasts, uterus, and ovaries at the request of her parents. They also used high-dose estrogen to force her growth plates to fuse and stop the growth of long bones.
Many people are outraged, accusing the parents of orchestrating the treatment to maintain a more "portable and manageable" child.
Her parents claim that the treatment was done to decrease Ashley's discomfort by eliminating menstrual cramps and bedsores. They also claim that there is a family history of breast cancer, but there is no mention of BRCA testing.
What do you think? Please comment below...