oshaku Posted November 5, 2015 Report Share Posted November 5, 2015 patient came to the clinic with 3 weeks of cough, green sputum and crackles in lung. I had no idea what to make of that even though I just finished my respirology block 3 days ago. I suck as a clinician. Link to comment Share on other sites More sharing options...
Organomegaly Posted November 5, 2015 Report Share Posted November 5, 2015 patient came to the clinic with 3 weeks of cough, green sputum and crackles in lung. I had no idea what to make of that even though I just finished my respirology block 3 days ago. I suck as a clinician. haha I'm curious, what was it? green sputum? pneumonia? Link to comment Share on other sites More sharing options...
Arztin Posted November 6, 2015 Report Share Posted November 6, 2015 patient came to the clinic with 3 weeks of cough, green sputum and crackles in lung. I had no idea what to make of that even though I just finished my respirology block 3 days ago. I suck as a clinician. most of your classmates don't know neither. Your preceptor sent the patient for an Xray i suppose? Link to comment Share on other sites More sharing options...
oshaku Posted November 6, 2015 Report Share Posted November 6, 2015 haha I'm curious, what was it? green sputum? pneumonia? most of your classmates don't know neither. Your preceptor sent the patient for an Xray i suppose? I'm not sure about that... all of the classmates whom I talked to about it came up with pneumonia, which is what my preceptor thought too. yup. patient left with X-ray papers in hand. Link to comment Share on other sites More sharing options...
Bambi Posted November 6, 2015 Report Share Posted November 6, 2015 Note that this is based on US reports without any tangible evidence. It would appear all parties agree it was a bomb, and Russia has stopped its flights. Link to comment Share on other sites More sharing options...
rmorelan Posted November 6, 2015 Report Share Posted November 6, 2015 I'm not sure about that... all of the classmates whom I talked to about it came up with pneumonia, which is what my preceptor thought too. yup. patient left with X-ray papers in hand. at the very least an X ray is probably required. could probably figure out a bunch more on physical though - as in exactly where the pneumonia likely is. Link to comment Share on other sites More sharing options...
Falling Posted November 6, 2015 Report Share Posted November 6, 2015 It would appear all parties agree it was a bomb, and Russia has stopped its flights. Yeah, I just saw. Putin will have to respond very strongly. Link to comment Share on other sites More sharing options...
rmorelan Posted November 6, 2015 Report Share Posted November 6, 2015 Yeah, I just saw. Putin will have to respond very strongly. because that always solves terrorism Link to comment Share on other sites More sharing options...
Bambi Posted November 7, 2015 Report Share Posted November 7, 2015 Unforeseen/unintended consequences - cause and effect. The question is will Putin experience a backlash or are Russians too intimidated to dare express unhappiness with him over this. The strong man grabbed Crimea and then had his proxies fight a war in the Ukraine - which resulted in the shooting down of a civilian aircraft by his proxies or his soldiers not in uniform. Well now, his civilian aircraft has been blown up - and there is nothing Putin can do about it, other than go defensive by curtailing flights to the region. Attacks result in some form of retaliation. It is unfortunate that innocent civilians suffer the ultimate fate. Link to comment Share on other sites More sharing options...
Falling Posted November 7, 2015 Report Share Posted November 7, 2015 because that always solves terrorism Putin has an image to maintain. Link to comment Share on other sites More sharing options...
Bambi Posted November 7, 2015 Report Share Posted November 7, 2015 What a difference a day makes. That is to say, Russia was sending one message and today another. Me thinks his image is being damaged. Link to comment Share on other sites More sharing options...
Falling Posted November 7, 2015 Report Share Posted November 7, 2015 What a difference a day makes. That is to say, Russia was sending one message and today another. Me thinks his image is being damaged. He's getting a lot of heat right now. Apparently a lot of Russians thought getting so heavily involved in Syria was not a good decision. It looks like it may have strongly contributed to the downing of this plane. This is the real reason why US/UK sources were so quick to release info implicating ISIS. Link to comment Share on other sites More sharing options...
Bambi Posted November 7, 2015 Report Share Posted November 7, 2015 And his options are limited other continuing his bombing attacks with even greater intensity. Then Isis might get one of their operatives into Russian territory, even Moscow, and create greater havoc. There will be no good ending. Link to comment Share on other sites More sharing options...
rmorelan Posted November 7, 2015 Report Share Posted November 7, 2015 And his options are limited other continuing his bombing attacks with even greater intensity. Then Isis might get one of their operatives into Russian territory, even Moscow, and create greater havoc. There will be no good ending. you cannot solve permanently this with bombing people. It just breeds more terrorists. Link to comment Share on other sites More sharing options...
Falling Posted November 7, 2015 Report Share Posted November 7, 2015 you cannot solve permanently this with bombing people. It just breeds more terrorists. Up until now, none of major players involved was interested in solving the problem. ISIS had a functional value to the US and to Russia/Assad. Link to comment Share on other sites More sharing options...
Organomegaly Posted November 7, 2015 Report Share Posted November 7, 2015 at the very least an X ray is probably required. could probably figure out a bunch more on physical though - as in exactly where the pneumonia likely is. lol like egophany and whispered pectoriloquiy? cool tests but does anyone actually use them lol Link to comment Share on other sites More sharing options...
rmorelan Posted November 7, 2015 Report Share Posted November 7, 2015 lol like egophany and whispered pectoriloquiy? cool tests but does anyone actually use them lol becoming bit of a lost art I admit - because basically radiology is taken over that function. Ha, it is almost like ER cannot move without radiology anymore. Being in the effective centre of the universe has its ups and downs. Dullness to percussion. Reduced breath sounds. Crackles? I mean some of this stuff is pretty basic I mean why are you bothering to carry around the stethoscope if you aren't going to actually use the silly thing. What would be important is to figure out if it is extensive or bilateral. That may sound silly - but an outpatient X Ray may not be read for a day or so in some places. Sometimes patients fail to actually go to get the X Ray (busy people, X Ray may be a bit of a trek, and may be giving some antibiotics at the fam doc, so think meh it will clear up - this happens all the gosh darn time). Ha, I had one patient once leave a FM and collapse on the way to the X Ray while driving that I got to read later when he ended up in ER. Gotta at least do the basic exam stuff here, it is kind of important Link to comment Share on other sites More sharing options...
Organomegaly Posted November 7, 2015 Report Share Posted November 7, 2015 becoming bit of a lost art I admit - because basically radiology is taken over that function. Ha, it is almost like ER cannot move without radiology anymore. Being in the effective centre of the universe has its ups and downs. Dullness to percussion. Reduced breath sounds. Crackles? I mean some of this stuff is pretty basic I mean why are you bothering to carry around the stethoscope if you aren't going to actually use the silly thing. What would be important is to figure out if it is extensive or bilateral. That may sound silly - but an outpatient X Ray may not be read for a day or so in some places. Sometimes patients fail to actually go to get the X Ray (busy people, X Ray may be a bit of a trek, and may be giving some antibiotics at the fam doc, so think meh it will clear up - this happens all the gosh darn time). Ha, I had one patient once leave a FM and collapse on the way to the X Ray while driving that I got to read later when he ended up in ER. Gotta at least do the basic exam stuff here, it is kind of important i'm definitely comfortable percussing and hearing crackles ( got to listen to crackles from a patient with asbestosis - was fun, and basic expiratory wheezes from a COPD patient) but things like tactile fremitus and egophany make me feel more uncomfortable. mainly because growing up and going to the doctor we were all auscultated and palpated. but nobody ever told me to say "ninety-nine" and felt for vibrations across my chest. too bad... Link to comment Share on other sites More sharing options...
rmorelan Posted November 7, 2015 Report Share Posted November 7, 2015 i'm definitely comfortable percussing and hearing crackles ( got to listen to crackles from a patient with asbestosis - was fun, and basic expiratory wheezes from a COPD patient) but things like tactile fremitus and egophany make me feel more uncomfortable. mainly because growing up and going to the doctor we were all auscultated and palpated. but nobody ever told me to say "ninety-nine" and felt for vibrations across my chest. too bad... well the other stuff is not as important - I mean you are going to get imaging if you are worried about the sort of pathology kicking around requiring that sort of stuff - and we will just tell you what you are likely dealing with then or at least frame it for clinical context Link to comment Share on other sites More sharing options...
Organomegaly Posted November 7, 2015 Report Share Posted November 7, 2015 well the other stuff is not as important - I mean you are going to get imaging if you are worried about the sort of pathology kicking around requiring that sort of stuff - and we will just tell you what you are likely dealing with then or at least frame it for clinical context yeah makes sense. been reading radiology by armstrong (basically a beginner book). so hard to actually feel comfortable interpreting chest X-rays though Link to comment Share on other sites More sharing options...
Birdy Posted November 7, 2015 Report Share Posted November 7, 2015 i'm definitely comfortable percussing and hearing crackles ( got to listen to crackles from a patient with asbestosis - was fun, and basic expiratory wheezes from a COPD patient) but things like tactile fremitus and egophany make me feel more uncomfortable. mainly because growing up and going to the doctor we were all auscultated and palpated. but nobody ever told me to say "ninety-nine" and felt for vibrations across my chest. too bad... My group got "toy boat" instead of ninety-nine, hah. I love how the various clin skills groups get these little variations. I also get a bit uncomfortable asking to perform them on patients just since they seem to be taught more for historical meaning than clinical utility. My husband and kids have been more tolerant. Automatic SPs. ive also never had these performed despite many resp exams throughout my life what with the lung issues. Ausculated and palpated a million times, sure, but none of the rest. It seems they really would do very little to increase or refine your suspicions of a particular process going on. Alos, check out http://radiopaedia.org if you want some practice with imaging. That and Figure 1. Link to comment Share on other sites More sharing options...
Organomegaly Posted November 7, 2015 Report Share Posted November 7, 2015 My group got "toy boat" instead of ninety-nine, hah. I love how the various clin skills groups get these little variations. I also get a bit uncomfortable asking to perform them on patients just since they seem to be taught more for historical meaning than clinical utility. My husband and kids have been more tolerant. Automatic SPs. ive also never had these performed despite many resp exams throughout my life what with the lung issues. Ausculated and palpated a million times, sure, but none of the rest. It seems they really would do very little to increase or refine your suspicions of a particular process going on. Alos, check out http://radiopaedia.org if you want some practice with imaging. That and Figure 1. apparently saying ninety-nine for tactile fremitus is inaccurate. its a relic of its german origins, and the vibrations produced by that noise aren't quite right in english. "boy oh boy" is allegedly best. awkward to say though....lol Link to comment Share on other sites More sharing options...
rmorelan Posted November 7, 2015 Report Share Posted November 7, 2015 Das ist richtig! neunundneunzig is more gutteral. Ha but it is German afterall. Link to comment Share on other sites More sharing options...
Birdy Posted November 7, 2015 Report Share Posted November 7, 2015 Learning the history behind the things we do is rather fun, though. The history of medicine is awfully interesting. Link to comment Share on other sites More sharing options...
oshaku Posted November 7, 2015 Report Share Posted November 7, 2015 Learning the history behind the things we do is rather fun, though. The history of medicine is awfully interesting. we have the most amazing medical historian. She's such an entertaining presenter and her stories are hilarious Link to comment Share on other sites More sharing options...
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