Favorite Quotes
"For every complex problem, there is a solution that is simple, neat, and wrong." - HL Mencken
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"I hear and I forget. I see and I remember. I do and I understand." - Confucius
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"The good physician treats the disease; the great physician treats the patient who has the disease" - Sir William Osler
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" The best test of a person's character is how he or she treats those with less power." - Bob Sutton
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"Those are my principles, and if you don't like them - well, I have others." - Groucho Marx
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"The difference between genius and stupidity is that genius has its limits." - Albert Einstein
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"It is hard enough to remember my opinions, without also remembering my reasons for them" - Friedrich Nietzsche
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"Anyone can make the simple complicated. Creativity is making the complicated simple." - Charles Mingus
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"Not everything that can be counted counts, and not everything that counts can be counted." - Albert Einstein
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"A foolish consistency is the hobgoblin of little minds, adored by little statesman and philosophers and divines. With consistency a great soul has simply nothing to do." - Ralph Waldo Emerson
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"This ain't no party, this ain't no disco, this ain't no fooling around." - Talking Heads, Life During Wartime
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"What is hateful to you, do not do to your neighbour. This is the whole Torah; all the rest is commentary. Go and learn it." - Hillel, Talmud, Shabbath 31a
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"You will never understand bureaucracies until you understand that for bureaucrats procedure is everything and outcomes are nothing." - Thomas Sowell
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"An idealist is one who, on noticing that a rose smells better than a cabbage, concludes that it will also make better soup." - HL Mencken
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"If you only have a hammer, you tend to see every problem as a nail." - Abraham Maslow
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"A great teacher is one who realizes that he himself is also a student and whose goal is not to dictate the answers, but to stimulate his students creativity enough so that they go out and find the answers themselves." - Herbie Hancock
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"There are no facts, only interpretations." - Nietzsche
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"An education isn't how much you have committed to memory, or even how much you know. It's being able to differentiate between what you do know and what you don't." - Anatole France
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"In character, in manner, in style, in all things, the supreme excellence is simplicity." - Henry Wadsworth Longfellow ====
Nov - 15
Dec - 19
Jan - 21
Feb - 8
Mar -
17 days at the VA – Day 4
18 Nov2009
First, we had a remarkably light admission day. We often cap at 10 patients. When you have a light day, the attending must provide more discussion and chalk talks. The ideal is 6 or 7 admissions.
Second, the team is stable. We are still puzzled about why our patient has SIADH.
Yesterday's teaching session covered reasons for an increased creatinine in a patient with known Stage III CKD. We imagined a patient with a creatinine of 2.5 last year who now comes either to clinic or the hospital with a creatinine of 3.5.
Here is my synopsis:
1. Plot 1/creatinine vs. time to look for natural progression of disease
2. Rule out obstruction – always rule out obstruction in any patient with newly elevated creatinine
3. Are the kidneys receiving adequate perfusion? This includes volume contraction and worsened CHF.
4. Drug toxicities – we mentioned (among many others) NSAIDs, Bactrim, aminoglycosides
5. A second kidney disease – patients with CKD are not immune from a second insult
6. IV contrast
7. Infection
For each step we included a discussion to provide more depth.
Related posts:
- 17 days at the VA – day 14
- 17 days at the VA – Day 1
- 15 days at the VA – day 14
- 15 days at the VA – day 1
- 15 days at the VA – day 10
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- In: Medical Rants
1 Response to 17 days at the VA – Day 4
17 days at the VA - Day 4 | disease database
November 18th, 2009 at 7:44 am
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