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 - 7
Mar -
17 days at the VA – Day 6
20 Nov2009
Day 6 we admit again. When I left yesterday we had 4 patients already.
Rounds yesterday focused mostly on teaching. As an attending, I make a 2 hour commitment to my teams. They get me for 2 hours and I get them for 2 hours, regardless.
Yesterday we reviewed my favorite diabetes mneumonic – the FLECKS. After that we focused on a problem from day 4.
On day 4 we had a patient who needed a BKA. This day my resident had off, so I functioned as a res-attending. Fortunately, at the VA we have an excellent EMR. After making rounds, I sit down to do my notes in the team room.
My notes have a template that allows me to review the medications and the labs. I quickly peruse both to be careful. In so doing, I noticed that the patient's phosphate level was 1.2. We did give the patient phosphate that day, and on the day of surgery his phosphate was above 3.
Why was I excited? If the patient's phosphate went lower, he would have serious problems due to decreased ability to produce ATP.
Why do patients develop acute hypophosphatemia? Generally it occurs due to total body phosphate depletion and then refeeding. We get refeeding either provide glucose that has been missing – alcoholics, anorexics, severe malnutrition for other reasons – or insulin that has been missing – DKA. Once the patient again has both glucose and insulin, the liver phosphorylates, using large amounts of phosphate.
So who cares? Am I just being an electrolyte geek?
Once the phosphate goes below 1.0, the patient enters a serious risk due to insufficient ATP. We label this severe hypophosphatemia
5 major concerns in severe hypophosphatemia
- CNS depression or seizures
- Cardiac arrhythmias
- Respiratory failure second to muscle weakness
- Rhabdomyolysis
- Hemolysis
The article gives more good information – Hypophosphatemia.
Time to go make post call rounds!
Related posts:
- 15 days at the VA – day 3
- 17 days at the VA – day 9
- The degradation of physician’s notes
- 17 days at the VA – Day 1
- 17 days at the VA – day 16
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1 Response to 17 days at the VA – Day 6
Carey
November 24th, 2009 at 1:01 am
Thanks for posting this very helpful review.
I've been away from blogging for a while, so it's good to see that your blog is still one of the most interesting and helpful medical blogs around.