From: Howard C. Berkowitz (hcb@gettcomm.com)
Date: Fri Aug 22 2003 - 14:12:00 GMT-3
At 12:43 PM -0400 8/22/03, Scott Morris wrote:
>#11 is a little vague. Should we ask the attending for more
>clarification on that?
>
>Also, #2 is a bit harsh. In the real world we'd likely use an IV push,
>but perhaps that's the difference between these silly lab exams and the
>real world, huh?
You bring up lots of parallels to the lab. In the real world, we'd
probably do it laparoscopically, and NEVER use BGP synchronization.
Hmmmm...and is budget to be considered? Any cost factor on propofol
versus ketamine (to say nothing about how the patient feels after
awakening) versus isoflurane?
Of course, the lab doesn't really get into what problem you are
trying to solve. IIRC, the Fourth Law of Emergency Medicine is "it is
impossible to diagnose abdominal pain in a female of reproductive
years without at least two consultations." And is ultrasound or CT
in the lab release train?
Does the lab respect the rule for appendectomies that if you don't
take out 10-20% normal appendices, you're being dangerously
conservative?
>
>For #5, would you recommend going with a vertical or horizontal
>incision? I know both give me the same result in the end, but I'm
>really not sure what people are looking for here. And with these
>auto-grading systems it's not just about the patient still living in the
>end!
>
>-----Original Message-----
>From: nobody@groupstudy.com [mailto:nobody@groupstudy.com] On Behalf Of
>Howard C. Berkowitz
>Sent: Friday, August 22, 2003 11:39 AM
>To: CCIE Lab group
>Subject: Re: Friday humor: New to Medicine
>
>
>At 10:38 AM -0400 8/22/03, Charles Church wrote:
>>Variation on a theme :)
>>
>>
>>Hi I am new to the medical field I have a quick question for you
>>doctors. What book should I read to be a surgeon? I read a book and
>>now I am veterinarian. I want to continue my learning and become a
>>smart medical guy. How can I get to the six figure plus salaries the
>>fastest? I have very little medical experience except using drugs and
>>a complete mastery of Milton-Bradley's 'Operation' board game but I can
>
>>really scalpel around to get this stuff working. I think brain surgeon
>
>>is the next logical step. Also I was reading about appendectomy and
>>forceps, does anybody have any good explanations of how these thingies
>>work?
>
>
>Appendectomy? Assuming an open rather than laparoscopic procedure
> 1. Diagnose appendicitis. This is often the hard part.
> 2. Put patient to sleep or at least use a spinal anesthetic.
> 3. Using a #10 blade, incise the skin and subcutaneous fat, directing
> the incision laterally and inferiorly through MacBurney's point
> 4. Changing to a clean scalpel, incise the four muscle planes and
>retract,
> with appropriate hemostasis.
> 5. With a new scalpel, incise the omentum and peritoneum.
> 6. Locate the appendix and double-clamp the stump. If there is
>peritonitis,
> call for help.
> 7. With a Metzenbaum scissors, cut between the clamps.
> 8. Rinse the area, suction, and suture the stump. Send appendix to
> pathology so they can tell you what you removed. If you removed
>the
> assistant surgeon's finger, you probably already know that.
> 9. Repair the incisions.
> 10. Wake up the patient.
> 11. Bill somebody.
>
>Was that clear?
>
>
>(begin standard rant about L3 switch), you have to realize the
>boundary between forceps and clamps is sort of like the boundary
>between routers and L3 switches. There is much more variability
>within forceps and clamps than among Cisco products. Offhand, clamps
>I've used include Kelly, Mayo, mosquito, Crile and Ochsner styles,
>with straight and bent tips, traumatic and atraumatic tip finishes,
>and an assortment of lengths.
>
>
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