#Medical Schools and Hospitals

[prasadmedicals]

How to Secure Competitive Rotations: A Guide for International Medical Students in the USA

Are you an international medical student dreaming of gaining valuable clinical experience in the United States? Securing competitive clinical rotations is a crucial step in your medical journey. In this comprehensive guide, we'll walk you through the process of obtaining clinical rotations in the USA, ensuring you're well-prepared for this exciting opportunity. Let's dive in!

Table of Contents

Understanding Clinical Rotations

What Are Clinical Rotations?

Why Are Clinical Rotations Important?

Eligibility and Requirements

Meeting Educational Prerequisites

Visa and Legal Requirements

Finding the Right Institutions

Researching Medical Schools and Hospitals

Utilizing Online Resources

Preparing a Strong Application

Crafting a Compelling Resume

Writing an Effective Personal Statement

Navigating Interviews and Evaluations

Acing the Interview

Excelling in Clinical Evaluations

Financial Planning

Estimating Costs

Exploring Scholarships and Financial Aid

Cultural Adaptation and Communication

Adapting to the US Healthcare System

Enhancing Communication Skills

Living Arrangements and Logistics

Housing Options

Transportation and Daily Logistics

Getting the Most Out of Your Rotation

Building Strong Relationships

Maximizing Learning Opportunities

Succeeding in the USMLE

Preparing for the USMLE Step 2 CK

Tips for Success

Understanding Clinical Rotations

What Are Clinical Rotations?

Clinical rotations, often referred to as clinical clerkships or simply rotations, are a fundamental component of medical education. During rotations, medical students have the opportunity to work alongside experienced healthcare professionals, gaining hands-on experience in various medical specialties.

These rotations typically last for several weeks and cover a range of disciplines, including internal medicine, surgery, pediatrics, and more. They provide students with a real-world understanding of medical practice, helping bridge the gap between theoretical knowledge and practical application.

Why Are Clinical Rotations Important?

In Prasad Medical Center, Clinical rotations serve several crucial purposes for medical students:

Skill Development: Rotations allow students to develop essential clinical skills, such as taking patient histories, performing physical examinations, and interpreting diagnostic tests.

Exposure to Specialties: They provide exposure to different medical specialties, helping students explore potential career paths.

Networking: Rotations offer opportunities to connect with practicing physicians and potential mentors in the field.

Residency Preparation: Successful completion of rotations is often a prerequisite for applying to residency programs in the United States.

Now that we've covered the basics, let's explore how international medical students can secure competitive rotations in the USA.

Eligibility and Requirements

Meeting Educational Prerequisites

Before embarking on your journey to secure clinical rotations for international medical students in USA, it's essential to ensure you meet the educational prerequisites. Most institutions require that you:

Have completed the core clinical clerkships in your home country.

Possess a strong academic record.

Demonstrate proficiency in English by passing exams like TOEFL or IELTS.

Visa and Legal Requirements

Securing the appropriate visa is a critical step in the process. International students typically apply for a J-1 visa, which is specifically designed for exchange visitors in programs such as clinical rotations. Be sure to:

Consult your institution's international student office for guidance on the visa application process.

Familiarize yourself with the legal requirements and restrictions associated with your visa.

Book Your Appointment online

Finding the Right Institutions

Researching Medical Schools and Hospitals

To secure competitive rotations, research is your best friend. Start by identifying medical schools and hospitals known for hosting international medical students. Look for institutions that:

Have established international student programs.

Offer a variety of clinical specialties.

Provide support and guidance for international students.

Utilizing Online Resources

The internet is a treasure trove of information. Explore online forums, social media groups, and websites dedicated to medical students. These platforms often contain valuable insights and firsthand experiences from fellow international students who have completed rotations in the USA.

In the next section, we'll delve into the nitty-gritty of preparing a strong application.

Preparing a Strong Application

Crafting a Compelling Resume

Your resume is your first impression on potential rotation sites. Ensure it highlights your:

Educational background, including your medical school and any honors or awards.

Clinical experience and relevant medical skills.

Extracurricular activities and leadership roles.

Read more: Clinical Rotations for International Medical Graduates in the USA - Prasad Medicals

Writing an Effective Personal Statement

Your personal statement should reflect your passion for medicine and your desire to learn and contribute during your rotations. Share your:

Motivation for pursuing clinical rotations in the USA.

Unique qualities and experiences that set you apart.

Long-term career goals and how rotations fit into your journey.

Navigating Interviews and Evaluations

Acing the Interview

Interviews are your opportunity to showcase your personality and dedication. Practice common interview questions and emphasize:

Your enthusiasm for the field and the institution.

Your ability to work effectively in a team.

Your commitment to providing quality patient care.

Excelling in Clinical Evaluations

During your rotations, clinical evaluations play a pivotal role in your success. Always strive for excellence by:

Being punctual and professional.

Seeking feedback and actively working on improvement.

Building strong relationships with residents and attending physicians.

Financial Planning

Estimating Costs

Understanding the financial aspects of your rotations is crucial. Consider expenses such as:

Tuition fees, if applicable.

Visa and application fees.

Living expenses, including accommodation and daily costs.

Exploring Scholarships and Financial Aid

Don't forget to explore scholarship opportunities and financial aid programs for international medical students. Many organizations offer assistance to help alleviate the financial burden.

Now that we've covered the essentials, let's discuss cultural adaptation and communication.

Cultural Adaptation and Communication

Adapting to the US Healthcare System

Adapting to a new healthcare system can be challenging. Here are some tips for a smooth transition:

Familiarize yourself with US healthcare policies and practices.

Be respectful of cultural differences in patient care.

Seek guidance from mentors and fellow students who have undergone a similar transition.

Enhancing Communication Skills

Effective communication is essential in healthcare. Work on your:

English language proficiency.

Listening skills.

Ability to convey information clearly and empathetically to patients.

Living Arrangements and Logistics

Housing Options

Your living arrangements can significantly impact your experience. Consider options like:

On-campus housing provided by the institution.

Off-campus apartments or shared housing with fellow students.

Transportation and Daily Logistics

Ensure you have reliable transportation to and from your rotation sites. Plan your daily logistics, including commuting time, meals, and study schedules, to make the most of your rotations.

Getting the Most Out of Your Rotation

Building Strong Relationships

Networking is key to your success. Build relationships with:

Residents and attending physicians who can provide guidance and recommendation letters.

Peers and colleagues for support and camaraderie.

Maximizing Learning Opportunities

Take every opportunity to learn and grow during your rotations. Be proactive in:

Observing procedures and patient interactions.

Asking questions and seeking mentorship.

Keeping a journal to track your progress and experiences.

Succeeding in the USMLE

Preparing for the USMLE Step 2 CK

As an international medical student, passing the USMLE Step 2 CK is essential for your career prospects. Prepare by:

Enrolling in a comprehensive review course.

Practicing with sample questions and mock exams.

Staying organized and focused on your study goals.

In conclusion, securing competitive clinical rotations for IMG in the USA as an international medical student is an achievable goal with careful planning and dedication. Remember to stay persistent, make the most of your opportunities, and always strive for excellence in your medical journey.

Frequently Asked Questions

1. How do I find hospitals that accept international medical students for rotations?

You can start by researching medical schools and hospitals known for hosting international students. Online forums and social media groups are also excellent resources for recommendations.

2. What is the best way to prepare for the clinical rotations interview?

Practice common interview questions, emphasize your passion for medicine, and showcase your ability to work effectively in a team.

3. Are there financial aid options available for international medical students pursuing rotations in the USA?

Yes, many organizations offer scholarships and financial aid to help international students with the costs of rotations.

4. How can I excel in my clinical evaluations during rotations?

Be punctual and professional, seek feedback, and build strong relationships with residents and attending physicians.

5. What are the key tips for succeeding in the USMLE Step 2 CK?

Enroll in a review course, practice with sample questions, and stay organized and focused on your study goals.

By following these guidelines and staying committed to your goals, you can secure competitive clinical rotations in the USA and make the most of this invaluable experience in your medical career.

Good luck!

Contact us for knowing more about the clinical rotations

Address: 894 Eastern Parkway, Brooklyn, NY 11213

Phone: +1 718-774-6060

Fax: +1 718-774-4426

[vyorei]

Here's an amalgamation of news from the last 2 hours

Schools, hospitals, the one road civilians are fleeing down, NOTHING IS FUCKING SAFE.

WERE YOU ANGRY ABOUT AL-AHLI? WELL HERE, THERE'S FUCKING MORE. BRING THAT RAGE BACK AND START MAKING NOISE.

[possamble]

Like take for example how she treats healing Laios leg!! We *never* see someone who was healed have lasting symptoms from a heal. It *itches* terribly — Laios looks like he will scratch it raw. The itching implies an incomplete heal — you only itch that bad when something is being regrown or scabbing like when you get tattoos. There’s something that needs to finish healing. This scene always stood out to me— because Falin notices and *heals* it. And that brought up a ton of questions for me (We see her cast magic, was it to soothe the itching? A phantom pain? Why was it itching in the first place? Didn’t Marcille finish the job? Why was he having after effects we never see someone have any before?) and i’m breaking my brain over it because is this an sign of Marcille’s engagement with healing in general? Perfunctory—a means to an end? Morals? I feel like there is something there for us because that scene wasn’t necessary to the plot so why did Ryoko Kui add this interaction? I think how Marcille engages with healing was telling us a lot more than I previously realized because she was in a medical researcher position before coming into the dungeon however when we see how this was practically applied by her was really interesting!! She’s so divorced from feeling empathy for the pain of healing and i think that’s some sort of self-preservation instinct. Idk i just feel like her engagement with healing is so fucking fascinating when juxtaposed with her beliefs on death pls share thots if any

I think what gets hidden in the details about Marcille’s healing is that no, she’s not a talented cleric and healer in the way that Falin is. But Fantasy settings tend to relegate healing towards “holy” and “good” magic that never causes harm—

and Marcille is what you’d get if you put a doctor and a surgeon with a modern, more realistic approach towards medicine in a genre that doesn’t usually allow for that. 

Like, you’ll see surgeons or doctors secretly being incredibly efficient serial killers in TV thrillers everywhere—but a fantasy series with a cleric or healer that’s secretly great at killing is a bit more rare to find(though not nonexistent, admittedly). Healing magic tends to be painted as either a religious discipline that’s not accessible to those who don’t have a tie to a deity or some ineffable force in the universe, or a matter of accessing some natural “life force” that exists in all living beings. 

Dungeon Meshi, of course, loves bending fantasy conventions in the most incredible ways, so that’s not how it works here. The series allows itself to contend with the fact that healing a human body requires extensive and painstakingly detailed knowledge of that body.

The reason that Falin might appear to be a much more talented healer than Marcille is because Kui dresses her up in all the archetypal traits of a Caring Cleric, and that immediately clicks with readers expecting fantasy conventions in ways that Marcille's expertise doesn't.

This isn’t to discredit Falin, obviously. She is a talented healer, as attested to by Marcille herself:

But the interesting thing is that she does it all on instinct, so it’s not an exact knowledge. Furthermore, she uses the gnomish system of healing, which is implied to rely more on the judgment and knowledge of natural spirits (and therefore takes less mana). So it’s not hard to imagine that she would have less exact knowledge of how the human body operates than Marcille does as a medical researcher. 

And that in and of itself raises questions: In a world where magic can immediately re-attach a limb, why would medical research be necessary? But Dungeon Meshi makes it clear that healing magic isn’t perfect, nor “holy” magic—it’s simply magic, like any other, carefully tailored to operate within the confines of what a human body needs in order to keep living. It’s not able to cure everything, and it especially seems to have gaps in terms of being able to treat illnesses that aren’t immediately solvable injuries.

And that all ties into Marcille's attitude towards it: It's a scientific and magical discipline like any other that requires careful study. There's nothing inherently good or bad about it—it was made by people, for people, and what matters is how you use it.

So, Marcille was at the academy, studying the ways that illness happens in a body, and carefully writing new magic to counteract or at least mitigate it.

(How I interpreted this was that she was likely part of research teams dealing with complicated things like autoimmune diseases, cancer, and other things where the body isn’t technically injured by a foreign element, but erroneously harming itself due to internal reasons.)

For me, this kind of explains her approach to pain in healing:

Honestly, what this immediately reminded me of was that a friend of mine had to have surgery on their throat when they were younger, and part of the procedure was waking them up without anaesthesia right after the surgery to make sure that they could still feel everything. They told me it was the worst pain they’d ever felt in their entire life—but from a medical perspective, it was necessary to make sure that none of the critical nerves in the neck had been affected. 

Sometimes in medicine, pain is necessary because it’s not some uncomplicated and bad thing—it’s a response of your nervous system, and sometimes the only indicator that your body is still working the way it should. And I think this is the mindset that Marcille has, which is why she seems so blase about it—she doesn’t think that she’s actually hurting people, it’s just a necessary part of the healing process. 

And in some ways, she just sees it as a realistic downside of the fact that you have to recover quickly in dungeon situations:

Normal recovery would take months. Healing magic shortens that to a few seconds. The pain is a result/tradeoff of forcing something that would naturally take a long time into such a short timespan. This all makes sense and is Right and Correct and Normal in Marcille's mind. It's not that she lacks empathy and doesn't care enough about not harming her patients: she doesn't think that it's "harm" at all.

Not a shred of guilt in that face before causing extreme pain. Contrast this to her constant fussing over Izutsumi on the smallest things—it's hard to believe she wouldn't even be a little apologetic if she actually believed this would be hurtful in a way that matters.

I think this is overall, less indicative of any lack of empathy so much as her incredibly stubborn and sometimes ridiculous way of compartmentalizing things to her own internal rules. I’d even argue that this mindset is preferable in surface situations, where people have the luxury of time. Dungeon healing hurts because it has to be fast and instantaneous—but if you're just treating a broken bone that can be put in a cast with slower healing magic to help, wouldn't you prefer that over an instant heal with the chance to cause brain damage, no matter how minuscule the chance is? Shouldn’t your long-term health matter more than short-term recovery and some pain?

To touch on Laios’s leg injury—we actually do see this kind of reaction to healing magic later on in the manga. When Marcille is teaching Laios how to heal, she ends up bowling him over because her cut gets super itchy:

but then she reacts positively and tells him that it's supposed to happen, before trusting him enough to try it on Senshi.

So while yes, it was an “incomplete” heal, I don’t think it was particularly telling about her approach to healing. And honestly, judging by the fact that it only distracted him when he was relaxed enough to be cleaning his armour before bed, it looks like she connected all the major muscles and nerves enough not to cause pain or risk re-injury by moving, but just left superficial stuff for Laios’s body to naturally heal. 

Her mindset makes sense in context: She also had to heal Chilchuck and Senshi, while conserving enough energy to immediately start digging for Falin’s body and potentially do a very taxing resurrection spell as soon as possible. 

After that, Falin healed the rest of Laios’s leg injury in a situation where it wasn’t needed, but there were no other high stakes to discourage it. Also, she can’t bear to see others in pain. ambrosiagourmet already did an incredible analysis of how this empathy doesn't really signify perfect altruism so much as Falin's deep discomfort with having to witness pain, so I won't go into that too much—but the important part is, Falin isn't inherently a more caring healer than Marcille. They are both making decisions for the patient based on their own approaches to healing—it's just that Falin's approach is preferable for dungeoneering overall.

(In Marcille's defense, it seems that dungeons are an incredibly specific environment that falls way outside the realm of what's actually taught to mages in most schools. Being a combat-oriented mage actually seems pretty frowned upon.)

So, in a lot of ways, Marcille is both realistic about dungeon healing (mana conservation by not doing full heals when not necessary, thinking about pain as the condensation of the time it would have taken to naturally heal, etc.) and very unrealistic about it. What she doesn’t realize is that the pain matters: In a dungeon, people have to be up and ready to continue right away, over and over. If it hurts every time, that makes them very averse to being healed, stressed out about getting injured, and affects their performance as dungeoneers.

All that to say… I personally believe that Marcille is very passionate about healing people. Not healing magic necessarily, but medicine as a whole. It’s not just a means to an end—it’s her main area of study only second to her research into ancient magic. And sure, she might have gotten into it because of her fear of death—but what I think people don’t give enough credit to is that her motivations changed from when she was a child. 

You see it here, when she’s laying her dream outright to the Winged Lion: 

She might be kinda racist herself, hypocritical, and short-sighted (mostly out of ignorance, I’d argue), but at heart, she hates that people hurt each other. She hates that long-lived races look down on everyone else just because of lifespan. She has—arguably very correctly—identified the disparity in lifespans as one of the main causes of interracial strife, and she wants to get rid of it so that everyone can fully understand and relate to each other as equals. 

And in some ways, it’s not even that insane of a dream. 

Knowing that people used to live as long as she’ll have to, and something changed in the eons since, is it really that weird for her to want to change it back somehow? 

But all that aside—the most important part of this to me is that… originally, she wasn’t actually that hung up on completely equalizing lifespans. She got into medicine because she wanted to, at the very least, close the gap as much as she could in her very long life. 

She was realistic about it at first. She thought that, by studying ancient magic’s ability to pull from the infinite, she could harness that infinite energy in tandem with medical knowledge to give more life to the short-lived races. 

But as she says it herself, it changed when she realized that she doesn’t have time to gradually unravel it on her own. 

So, yes. She got desperate. She got crazy. In light of all she did as dungeon lord, it’s easy to assume that she never cared much about healing as a profession, and is just a self-obsessed little girl caged by her trauma and trying to change the entire world to make sure she doesn’t have to be hurt. 

And… she is all that. She's my blorbo supreme but I'll be the first to insist that she is very much a complete hot mess. But my point is that these were very extreme circumstances, and Ryoko Kui has given us all the understated evidence we need to know that she’s actually a very passionate doctor otherwise. This is the girl who freaks out if she’s not useful to other people and not allowed to help:

Did actually get excited about making safe dungeons for helpful purposes beyond just learning more about ancient magic to fulfill her dream: 

And in tandem with her own personal trauma—not in opposition to it or to obscure it—cared about making life more peaceful and equal for everyone in the world. Not to mention, she had to have done some insane work to be acknowledged as the most talented researcher at the academy and be allowed onto teams that were researching new healing magics.

TL:DR, I think she has a lot of empathy for people and passion for helping them, it’s just expressed in a way you wouldn’t expect in a fantasy because Ryoko Kui doesn’t fuck around with her storytelling and genre subversion. She might not be a good archetypal healer, but she's an extremely knowledgeable doctor with a point-blank and intense attitude towards healing and medical treatment (see: her strictness about physical touch when teaching Laios about healing).

For me, all evidence points towards her going back to what she was doing before the story on top of her duties as Court Mage, kind of becoming a sort of Surgeon General for Melini as the head of health and safety for the country and whatnot. 

PS. I will admit that there's explicit evidence she's not good at healing here:

But this was also like... chapter 3. Written years ago. I personally feel that everything Kui has said about Marcille's background since is enough evidence that it was just a one-off joke before she had an airtight idea about who Marcille was and would be, but I'll concede that it's mostly conjecture.

But again, as I said, I believe that while she might not be the best at the heal spell that's used in Dungeons, she's passionate about being a medical researcher and the field of medicine as a whole.

[justkidneying]

Why the Spleen Sucks

The spleen is a really shittily placed organ, making it prone to injury. This injury is usually severe and can lead to death if not properly managed. We're going to look at the function of the spleen, what happens when it is damaged, and how to write about.

Where is the spleen? It's in the upper left quadrant of the abdominal cavity, nestled right against the ribs (typically 9-11) at the midaxillary line. It's behind the stomach and is considered intraperitoneal. The main thing is that the spleen is very vulnerable. It is literally right up against the ribs without much protecting it. It's shaped like a little bean and is purple in humans. It is fed by the splenic artery, which comes off of the celiac trunk (which sticks off of the abdominal aorta).

What does the spleen do? Its main job is to filter out old and malformed red blood cells. It also holds immune cells. Certain diseases can cause the spleen to enlarge, including cirrhosis of the liver (it's connected to the hepatic portal system), sickle cell anemia (RBCs are stuck in it), and autoimmune disorders. The spleen also holds about 250 mL of RBCs in reserve in case you need them.

What happens when it is injured? The spleen can be ruptured and lacerated kinda easily. Blunt trauma to the ribs can cause it to rupture, and this is seen in contact sports and car accidents mostly. Because of those giant gaps between the ribs, it's also prone to injury from knife attacks. Gunshot wounds are another common cause, as well as broken ribs penetrating it (broken ribs are very sharp, like way sharper than you imagine). Rupture is more likely when someone has splenomegaly.

When the spleen is damaged, you're going to get a lot of intraperitoneal hemorrhaging. The spleen filters a lot of blood and has blood in it, so there's going to be a lot of blood in the abdomen (obviously). This will lead to distention, guarding (abs are tense), and hypovolemia. The left upper quadrant will be painful, and there can also be referred pain to the left shoulder (Kehr's sign).

If the patient has a small laceration, the symptoms aren't always as dramatic. Sometimes they'll just have low hemoglobin (which is on RBCs), maybe some thrombocytopenia (lots of platelets in the blood).

How do you fix this? If the injury is small and the patient is hemodynamically stable, they can usually be given a blood transfusion and the spleen can heal itself. Sometimes surgery is also performed to clamp a vessel or repair the outer layer of the spleen.

If the injury is major, then surgery will be performed. If the patient is less critical, they may go in and try to fix the problem. If it can't be fixed, they may do a splenectomy (remove the spleen). In a critical patient, they might forgo the nice pretty incision on the left side, and instead just split the patient down the middle. In these situations (in my experience), there isn't a lot of time to waste. One thing that we aren't going to waste time on is anesthesia, for example. This is with a lot of very critical surgeries, at least from what I have seen. Like the surgeon will start cutting as they are working on knocking out the patient, but usually they are in so much pain that they don't even register it.

If you remove the spleen, the patient is more at risk for infections, but with modern medicine and vaccinations, it's not as much of a big deal as it used to be. The patient will probably be fine.

Writing tips: (new section idea, hope you guys like it, lol) As with any injury, you have to make sure that you are giving them an acceptable mechanism of injury. With the spleen, this is either blunt trauma or penetration/laceration. Getting tackled, getting stabbed, getting shot, all great MOIs.

Second thing, present the appropriate signs and symptoms. A sign would be like bruising, hypotension, tachycardia, etc. A symptom would be LUQ pain, Kehr's sign, etc.

Next, figure out what you're going to do and where you're going to do it. In the field, there probably isn't much you can do. The most would probably be a laparotomy and clamping the splenic artery, but I mean, when I was an EMT, we were not doing this. There's a lot of stuff you can theoretically do, but never gets done. But I mean you can write it. If the patient makes it to the hospital, I think it would be more fun to do emergency surgery and just split them right down the middle. There's going to be a lot of blood in the greater omentum, very high stakes and exciting.

Anyways, hope you guys liked this, please let me know if I got anything wrong. I wrote this off of my personal experience and a few good textbooks, but there can always been mistakes in things.

[pastelchad]

Sekaiichi hatsukoi is so much fun bc the tyrannical boss who takes their job way too seriously and the new employee who doesn’t know a damn thing is such a relatable concept and you can plop the entire cast into whatever au you want and it would still work just as well

[linastudyblrsblog]

Between the OR and the ICU always finding some time for coffee 🤍

[motivatemycollegelife]

On call room

[elenstudiesbiomed]

Hello everyone! It’s been a while since I’ve posted anything! In the past 7 months I finished my bachelor thesis and completed my internship at the hospital where I spent 4 weeks in each department (Haematology, Biochemistry, Pathology, Immunology and Microbiology)!

[my-life-my-stories-my-love]

So I have something called slipping rib syndrome. That means that I was born with floating rib and then suffered a chest trauma that caused my ribs to move or “slip” out of place and aggravate the surrounding nerves. This is extremely painful and relatively unheard of.

It took me 13 doctors and nurses to get diagnosed and when I finally was it was by a medical student. Everyone told me it was all in my head and I just had anxiety and needed to go to school. I was also told when pointing out a lump near my ribs (which turned out to be my slipping ribs sticking out) that I was just skinny.

I ended up missing 148 days of school due to the pain because some days I couldn’t even get out of bed let alone walk across my high school huge ass campus.

The worst part is this is normal for slipping rib syndrome in teenagers and younger children. The surgeon I saw said that my story of the multiple doctors and nurses and being told it was in my head was common and he heard that story all the time from his patients.

I don’t know what is happening to the medical field but not everything is in people’s head and it pays off to take them seriously. I cannot even begin to count the number of people I know who can say that doctors and the medical field generally suck and that they aren’t taken seriously. Especially with women and teenagers and it’s such bullshit. Everyone should be taken seriously when it comes to the physical and mental care no one knows you better than yourself. And I know some people genuinely have their medical issues come from within the head/brain but that should still be taken seriously and not brushed off.

Medical professionals please take note and take your patients seriously. And NEVER dismiss them and refuse to listen and provide options for treatment and testing.

[ketchup-chup]

I have an idea for a KHR hospital AU where all the acrobaleno are different kinds of doctors/work in different departments at the hospital but Skull is just a regular guy who’s always there because he gets injured so much

[mapetitefeedeslilas]

anaesthetists are the Jehovah witnesses of the hospital: every time you happen to be within 4 metres of them or dare to look at them in the eyes in the OR they'll jump over very excitedly "hi! Have you considered anaesthesiology for your future? I can tell you about what we do, would you like that?"

Doctor, your patient is talking when he should be sleeping. Please delay the proselytism and take care of him

[justkidneying]

Shock

SHOCK! Everyone loves writing about it, so we're gonna talk about it.

What is shock? Shock is a condition in which the blood flow in your body is no longer able to sustain the function of critical organs. We call this hypoperfusion. Blood carries a lot of stuff, but most importantly, it carries oxygen. When your tissues don't have oxygen, they're hypoxic. If they're hypoxic for long enough, they die.

What does shock look like? The patient might have hypotension, syncope (fainting), chest pain, abdominal pain, cool fingers/toes, shortness of breath, and/or altered mental status (I know you guys love that last one, lol).

What are the stages of shock? Trigger Insult -> Compensated Shock -> Uncompensated Shock -> Irreversible Shock (organ failure) -> Death

Not all of those stages are obvious in every patient, but that is the general progression. So, what does that all mean? It means that first, something is going to happen (trigger insult). This could be trauma, sepsis, anaphylaxis, heart attack, etc. Something has gone wrong with the normal blood circulation (we'll talk about what in a moment).

Next, the body will compensate to maintain perfusion and keep blood pressure normal. This can cause an increase in heart rate, constriction of blood vessels, rapid breathing, stress, and cool extremities.

When the body can no longer compensate, shit goes wrong. Mechanisms are failing, blood pressure is falling, and the organs are in dysfunction. You may see confusion, syncope, weak pulses, and metabolic acidosis (that's actually deadly but not as fun to write about, lmao).

Finally, when shit has gone very, very wrong, you get organ failure. If there were no interventions in the previous stages, the organs will begin to shut down. Heart rate, blood pressure, and respiratory rate will freefall. The patient will no longer respond to interventions. The nervous system's electrical activity will fade, and the patient will go into a comatose state. Then they die.

The Five Types of Shock

Distributive: this is from the dilation of vessels, which drops the blood pressure to unacceptable levels. This can be do to anaphylaxis, sepsis (bacterial infection), or adrenal crisis. One thing to note with this type is that the skin at the extremities will be warm, not cold.

Cardiogenic: the heart is not working correctly. This can be do to heart disease, heart attack, arrhythmia, etc. This leads to low cardiac output but constricted peripheral vessels. This may present with pulmonary edema.

Hypovolemic: this is from low blood volume. This can be due to hemorrhaging, severe vomiting (or, on the other end, pissing out your butt), or severe dehydration. The patient will have cold extremities and may be pale. Usually, this type of shock is easy to spot because there's either blood everywhere or some other type of trauma causing internal bleeding.

Neurogenic: this is due to nervous system failure from injury to the brain or spinal cord. Note that this type of shock does not have a fast heart rate. Since the autonomic nervous system is non-functioning, there is no response mounted to the shock.

Obstructive: this is a blockage of circulation to the heart. There are two types, pulmonary and structural. Pulmonary is due to increased pulmonary circulation resistance. This can be due to a tension pneumothorax or a collapsed lung. Structural is due to resistance in the heart, such as with cardiac tamponade (fluid in the pericardial space). This case of shock requires you to realized that there is clinically a right and left heart, as the blockage of either side will result in vastly different symptoms and require different treatment.

How do you treat shock? For treatment, it really depends on the type of shock. For all types (except that caused by pulmonary edema), you should give the patient a saline IV to increase blood pressure and volume. Then, it really depends on the case as to what you do next. For distributive shock, you want to give the patient vasoconstrictors (like norepinephrine or vasopressin). For cardiogenic shock, give them inotropes (to increase cardiac output). For hypovolemic shock, fix whatever was torn up and give them IV fluids. For neurogenic shock, you can give fluids and vasoconstrictors. For obstructive, fix whatever is wrong, like breaking a clot or draining the pleural cavity.

Okay, I hope this is a good guide. I think hypovolemic and distributive shock would probably be the most fun to write about, but I mean you could probably make any of these pretty interesting (except obstructive, maybe). Let me know if you have any questions in the notes (is that what the reply thing is?? or are they called comments??)

[news4dzhozhar]

[mad-hunts]

barton creating a drinking game while watching house m.d. on the basis that him and matilda take a shot every time doctor house commits medical malpractice might be both the most dangerous but also genius game ever if you want to get drunk QUICK... a little too quick, if you ask me LMAO

[linastudyblrsblog]

Fifth week in anaesthesiology and ICU care unit

Spending half of the day in the hospital’s library to revise and take notes

[songbird786]

miss me?

disclaimer: I’m not an official doctor (not yet at least) 🥲

would you trust me to do your surgery? (kidding!)

school is so damn tiring I had to draw myself 😭

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