General Medical issues thread

[coriander]

A couple of posts over on "Ask The Pilot" regarding mnemonics.
They obviously worked as it's 50+ years ago that I learned the twelve cranial nerves' mnemonic actually taught us by our Year 2 anatomy tutor and I can still recite it - "Only Old Officers ........ A Gorgeous Virgin At Horsham". Did you medicos have same/similar mnemonic or was it confined to us degenerate vets and students?

 

[Quickstatus]

medicos

Much simpler: ABC - airway breathing circulation

Wikipedia has some interesting ones that i have never used.

 

[RooFlyer]

I'm not familiar with heparin or 'bridging'. I was told to get off Xeralto 4 days prior to my op ( with cardiologist 's OK) and back on 2 days after. It's been 3 years since my last afib episode, so I guess risk was low.

 

[JohnK]

Even in the best of hands, outcomes are never 100%.

The outcome that is 100% is the mortality rate of the human race, even in the best of hands….


That would not have prevented would breakdown. Dressings are just a cover…

I had a fellow come into emergency asking about the thing on his chest and what he should do about it. It was an ECG dot from the last admission.

This is the main reason I've decided against any non life threatening surgery for the rest of my life. I'd definitely need hip replacement but I'm going to suffer rather than risk complications because these things happen.

The nurses were totally incompetent. They should have seen the stitches were not quite healed when they chose to do away with the dressing.

 

[Quickstatus]

I'm not familiar with heparin or 'bridging

It was ubiquitous in the era of warfarin. Warfarin takes several days to be effective. So initially when taking warfarin, there is no Blood thinning effect.
In comes injected heparin (an injectable blood thinner) which is effective from the moment of injection. And so heparin bridges the blood thinning effect until warfarin takes effect.

The newer oral anticoagulants such as xarelto and eliquis start working within hours.

The downside of the newer xarelto/eliquis is unlike warfarin there is no easy way to measure its blood thinning effect and until recently no easy way to reverse its blood thinning effect. Overall however much better than warfarin

 

[RooFlyer]

The downside of the newer xarelto/eliquis is unlike warfarin there is no easy way to measure its blood thinning effect and until recently no easy way to reverse its blood thinning effect. Overall however much better than warfarin

Yes, that what scares me about being on Xeralto. What if I need urgent surgery?

 

[Quickstatus]

scares me about being on Xeralto

Dont, they will just get a hematologist involved and if the risk of bleeding outweights the risk of reversing the xarelto they may give you an antidote which is available these days (Care of your Red Cross blood donor)

 

[prozac]

Yes, that what scares me about being on Xeralto. What if I need urgent surgery?

Or you fall over and bang your head, or have a car accident and have internal bleeding, or ... all a bugga on Xeralto, or used to be.

 

[coriander]

I'm not familiar with heparin or 'bridging'.

I'm usually on Eliquis due to history of DVTs and PEs as sequelae of MM. My haematologist told me to stop Eliquis T-3, use Clexane injections T-2, T-1, nothing on day of surgery,
Heparin midnight after surgery, then midday and midnight T+1, then midday T+2,3,4,5,6.
Restart Eliquis twice daily T+7 (ie tomorrow). Need another round of bloods tomorrow though as WCC and folate have fallen.

Whilst on Eliquis, I fell heavily hitting my head when my dog tripped me up on the boardwalk. By the time I got home the t-shirt on my shoulder and back were soaked with blood but it had all clotted and stuck to me Gave Mrs C a bit of a fright, probably would have me as well but I couldn't see it!

Not allowed to take dog for walk any more .

 

[Pushka]

I'm not familiar with heparin or 'bridging'. I was told to get off Xeralto 4 days prior to my op ( with cardiologist 's OK) and back on 2 days after. It's been 3 years since my last afib episode, so I guess risk was low.

It’s so you don’t bleed out on the table using usual anti-coags but still have some protection against clot formation.

 

[MARTINE]

A couple of posts over on "Ask The Pilot" regarding mnemonics.
They obviously worked as it's 50+ years ago that I learned the twelve cranial nerves' mnemonic actually taught us by our Year 2 anatomy tutor and I can still recite it - "Only Old Officers ........ A Gorgeous Virgin At Horsham". Did you medicos have same/similar mnemonic or was it confined to us degenerate vets and students

Our cranial nerve pneumonic was much flithier than that

 

[Pushka]

It was ubiquitous in the era of warfarin. Warfarin takes several days to be effective. So initially when taking warfarin, there is no Blood thinning effect.
In comes injected heparin (an injectable blood thinner) which is effective from the moment of injection. And so heparin bridges the blood thinning effect until warfarin takes effect.

The newer oral anticoagulants such as xarelto and eliquis start working within hours.

The downside of the newer xarelto/eliquis is unlike warfarin there is no easy way to measure its blood thinning effect and until recently no easy way to reverse its blood thinning effect. Overall however much better than warfarin

Weirdly I was put on to Xarelto at the Hospital (after days of heparin) but niece in her thirties put on to Warfarin by Rheumatologist (same one as mine). The specialist knew from her blood markers (and my history) that she would likely get a DVT (which she did) and like mine, in a weird place (not calf or PE). We both have APS. I didn’t want to go on warfarin as mum was on it and either had a bleed or another stroke and died just 6 weeks before I ended up in hospital.

 

[Quickstatus]

Restart Eliquis twice daily T+7

yes the other reason for heparin bridging is that it is easy to reverse heparin. In the immediate postop period where the risk of bleeding is higher heparin is used because it can be quickly reversed if postop bleeding occured or is a re-operation is required.

 

[coriander]

Our cranial nerve pneumonic was much filthier than that

I intentionally left out any reference to the Trochlear, Trigeminal and the Facial...... (didn't want to end up in the AFF sin-bin) . But in the paraphrased words of Penn and Teller "I think we both know how this went"'.

 

[Katie]

Apparently I'm a bad Mum because the Teen is back at school today ... (according to colleagues and the post-op call from the hospital earlier). OK, I'm exaggerating the "bad" bit, but that's the vibe I'm getting that the Teen isn't languishing in bed, continuing to suck in ALL Of The Internet, and eat popcorn.

At least it's a short week with the Ekka holiday in the middle ... and it's not like I'm making them catch the bus to and from school, and deal with the big hill for getting from the bus stop up to school.

(The Ortho gave us no particular restrictions on movement and activities; no heavy lifting, no crazy activities, but not really to stay in bed or avoid the stairs in our house)

 

[Katie]

Oh, and for the first time since the year the Teen was born, thanks to all those medical appointments occurring in one calendar year, we've hit our Medicare safety net.

Um, yay??!!??

 

[VPS]

Oh, and for the first time since the year the Teen was born, thanks to all those medical appointments occurring in one calendar year, we've hit our Medicare safety net.

Um, yay??!!??

yea me too but I had to spend a lot to get there and I'd rather have not

 

[k_sheep]

Our cranial nerve pneumonic was much flithier than that

Oh, oh, oh to touch and feel Virgin (it's an airline so it's okay?) girls *cough* and *cough*?

My favourite is still remembering taxonomy - kinky people come over for great sax (kingdom, phylum, class, order, genus, species).

 

[VPS]

Oh, oh, oh to touch and feel Virgin (it's an airline so it's okay?) girls *cough* and *cough*?

My favourite is still remembering taxonomy - kinky people come over for great sax (kingdom, phylum, class, order, genus, species).

I can never remember my taxonomy but I think this might help me - thanks

I remember having to learn about clotting factors 2 7 9 10 and this is showing my age but it was the 4 TV stations in Adelaide

 

[k_sheep]

Clearly the mnemonics work - I haven't had to do a cranial nerve exam for well over a decade.