Doctor talk, translation help, please.

Factual Questions
21

One more;

Why when you have me hooked to all this technology (heart rate monitor, BP gauge that takes the pressure every 3 mins, etc.) would they still take my pulse? Or turn my head to stare at my neck veins? Isn’t that a little redundant?

They could see on the monitors how high the BP was, and that my ticker was over 130, so why is everyone in the room suddenly taking my pulse? Don’t they already have that info, right in front of them?

But, of course, it was clearly no time for annoying questions, besides which, I truly felt cruddy in a way I have never before.
And another thing why isn’t the internist (never had cause to see one before, so wildly uninformed!) more interested in the things, y’know, inside you? Wouldn’t that make a lot more sense. I don’t think he looked into a single orifice. It was like playing 200 questions, the direction of which was wildly unpredictable. I was expecting him to look at my insides, but instead he just asked a zillion questions. Oh, and he was like a judge, dead serious, and zero facial expressions. Quite odd really.

22

At least they didn’t refer to you as the SOB patient.

SOB- short of breath.

23

Sorry, should have been clearer, I had the test 3 times, but there were like a dozen leads, chest, shoulder and then, oddly, one way down on my leg calf.

24

Actually, I misspoke the internist did look into my eyes, with his pointy light, for a long time and his face right up to mine. So there’s that.

25

The electrical activity of the heart (monitor) and the mechanical result of muscle contraction(pulse) are two different things. When everything is righteous, one follows the other in lockstep, when shit is wonky how they differ can give useful information.

Distended neck veins, easier to see with your head turned, are a sign of fluid distribution just like ankle swelling.

ETA maldistribution

26

So they were thinking my pulse would be actually different from what the monitor said? (Sorry, if I’m being dense.)

27

  1. The pulse thing- usually you check the pulse not for the number, but to see if it’s the same as the other side. IE: is the left and right pulses matching, and do they match the heart beat. This was beaten into me back when i was starting out as a student, when we discovered a patient on Day 3 of having asymmetrical pulses… and then turned out to have an aortic constriction… which was explaining his fainting spells. For 3 days people were looking all around the heart, BP, GI, everything trying to figure out what was up with the guy. Easily solved
    the one time someone decided- hey, why dont I check the pulses too?*

  2. Internists are Internal Medicine Doctors, but their goal is more "In-patient (Hospital) medicine too. Another term is Hospitalist- a doctor who specializes in Hospitals. Imaging studies are nice, but each imaging study carries its own set of risks/contraindications/and complications- such as allergic reactions, dyes causing renal failure, the ever-so-slight risk of radiation, etc.
    –>And again, it’s drilled in to us, students when the attendings ask us: “What do you want to do for the patient?” -if we say “Imaging/Xray/ETC”, the immediate follow up by them will be “Why? What are you going to look for?”

Imaging tends to be used more to confirm/assess a problem AFTER it is suspected, shooting blindly with imaging studies and then asking questions 2nd isn’t really encouraged. It cuts down on costs, and is less invasive to ask the Pt a ton of questions rather than just sign them up for a couple thousand dollar MRI test.

*Dramatized for humor.

28

Do potential MDs and pharmacists get quizzed on every one of those suckers?

29

Thankfully no. But it starts to become a LOT quicker when furiously writing notes your first two years to start picking up the certain shorthand ones.

30

Electromechanical disassociation, fun stuff :smiley:

31

Just one more.

Why were they so reticent to remove the IV thingy. Right after the ‘tacky’ park I was robed, moved to pod A, and hooked up to a lot of monitors, and clearly not returning home that night. An IV was set and liquids were pumped along with things like, potassium, magnesium, and some other things I’ve forgotten.

Within maybe 12 hrs, I was moved to a ward, and no more pumping stuff in. But they flat out refused to remove the thing in my arm until almost 10 mins before I was released. They flushed it with salt water everyday but refused to remove it. What was that about?

32

Because should there be an emergency and you need fluids, medications, anything via IV STAT, it’s always nice to have a patent and already placed IV. Trying to find a vein in the middle of an emergency situation is not optimal, and especially if people are a hard stick.

So once the line is placed, that’s the first choice for all things to go through IV if possible. And if not needed, keep it until you’re pretty much ready to go out the door.

33

To clear up, an EKG/ECG (same thing, the K is for the German word) can be 3 lead, 12 lead, or more. Sounds like you probably had a 12 lead EKG.
The abbreviations aren’t directly tested, although we did have some questions about how to write prescriptions scattered on a few tests 2nd year of med school.
Checking your pulses is important not just for possible asymmetry, but also just seeing if it’s present or if it’s much stronger or weaker than expected.
Checking the side of your neck can be for a few things. Flat veins could indicate you are dehydrated. The movement of your jugular vein as your heart beats can indicate difficulties with your heart or problems with return of blood to your heart. How high it is can tell you if things are backing up because of possible right sided heart failure. Pushing on your liver and watching the pulse can tell you about where the source might be. If they listen to your carotids they can hear for bruits which can indicate carotid stenosis.
There are a ton of physical exam findings that are all sort of falling out of practice because we have so many tests and images we can use, but these are some of the more basic ones that every doctor should be trained in.

34

Nursing students do. They’re integrated into test questions, and if you don’t know what they mean, you won’t interpret the test question properly. To make it more fun, there’s nothing “official” about any of them. You might have one doc write TID and another 3XDay and you’ve just got to figure it out (or call if you’re not sure.) There is, however, a list of abbreviations you’re NOT supposed to use, because using them increases the chances of errors: A Trusted Partner in Patient Care | The Joint Commission People still use them, though.

One nitpick, however: TID means 3 times a day, yes, but it does not mean every 8 hours. Q8h or Q8° means every 8 hours. If it’s every 8 hours, that means I get to wake you in the middle of the night for a dose. If it’s TID, we just divvy the daytime hours up, which usually works out to one at (or before) breakfast, one at (or before) lunch and one at (or before) dinner. Or waking, midday and bedtime, if that works better for you. TID means it’s not as crucial that a medication be taken at precise times, which means it’s probably a longer acting drug, not one with sharp peaks and troughs.

There’s the emergency thing, for sure. Presumably if you’re sick enough to be in the hospital, you may become sick enough to need something in the IV, and during an emergency is never the best time to place a line.

But also, docs have this annoying habit of finding one last thing to run in to you at the last minute. You can throw your whole schedule off whack, not to mention causing extra pain and using extra supplies, if you d/c (that’s “discontinue” or “pull out”) the IV too soon. Doc suddenly decides one more bag of Magnesium before you go, and now I’ve got to stick you again. Not fun for me or for you.

35

Oh yeah, in lots of different ways. A nerve impulse (not really electrical, but it’s a convenient shorthand), travels through the heart and tells the muscles when to contract. This is the classic line on the monitor. What the muscles actually do can be different. Sometimes it doesn’t contract at all, sometimes early so the chambers are still empty and no blood is ejected, if you are really tachy the heart may not have enough time to fill between beats and your pulse could be weak (usually associated with low blood pressure). You said they gave you potassium and mag? If your electrolytes are out of wack, it can cause the shape of the EKG to be distorted enough that the monitor will think your heart rate is twice as fast as it really is. The list goes on.

Only one of many

36

Thank you all so much for the information, you’ve been exceedingly helpful, truly.

Googling wouldn’t work as I didn’t have enough jargon understanding to really know what to look for, I tried.

Lovin’ the learnin’! How truly fortunate I feel to have such a community, as a resource, y’all are awesome!

37

Seems most of the translation questions were answered before I could get here… That’s what I get for working today…

elbows, if you have any other translation questions, feel free to ask.
Oh, and for the record, in Pharmacy School, we had tests on the sig codes in our first quarter of school. After that, we were assumed to know them, when we had practice prescriptions, or test questions.
Hirka T’Bawa, PharmD.

38

I didn’t see if this was answered or not, but the probable reason they were asking you to bend your neck was to check for meningeal irritation. The meninges are a set of 3 layers of tissue that covers your brain down into your spinal cord. Bacterial/viral meningitis, the scary infection that undergrads in dorms are usually worried about, is an infection of that lining, but plain old meningitis (-itis just means inflammation) can also be caused by blood. Bending your neck causes pulling on the meninges which causes pain if the meninges is inflamed. Given a very high blood pressure, one of the things they worry about it a bleed in your brain, so they were probably checking for that.

39

One of the comments, up thread, about a short physical exam possibly excluding expensive tests, got me to wondering.

Where I live we have universal health care, so there were no out of pocket expenses ,(beyond filling my scripts), upon release. And even then, when they discovered I had no health plan, at my work, they gave me a 3 month supply of the dearest drug. But it made me think, what might the bill have looked like, for this care, if I were 2+1/2hrs south, in the US.

Let’s see if I can remember all the things they did to me; 2 X CT scan on my head, (first presentation was wicked headache!), followed by a spinal tap, to check for blood in case it was anyurism, I believe. Of course a lot of blood work and a merciful shot of morphine. 2 days later I was in emerg again, more bood work, more morphine. When my stats were way too high, they started giving me 5mls of something to bring my pressure down, then the cardiac fellow said giver her 15ml, and grew alarmed because the stats were going up instead of down. From here it’s a little fuzzy, but I recall having two ECE’s, xrays of chest and abdomen, tested for C dificile (2hrs where only the masked and gowned were allowed in), an ultra sound of my heart, 6 days hospitalization, day long urine test (why are they keeping it on ice? I understand wanting to know how much I peed, on ice, not so much!)blood work every day, fists full of meds, a sleep test (blood oxygen?), and another ECE before being released. I’ve probably missed something but that’s most of it, I’m sure.

So, anyone care to make a wild ass guess what this care might have cost me, out of pocket, if I were in America?

And, in the awesome, who knew?, department, it turns out the Dr, who’s care I was in, at hospital, and who wants another sleep test in two weeks, is the premier specialist in the field of hypertension. It has been his life’s work and he has published more material about it, in 10yrs, than any other Doctor in this country. He is very widely admired and respected as ‘the Guru’, according to my family DR.

I doesn’t hurt to live in a medical hub with a teaching hospital!

All wildass guesses welcome! I can’t imagine going through all of this stressful experience and then also have to worry about losing the house, college or retirement fund, or just how to pay for it.

40

Your cost would be minimum $10-20k in the US.