Tuesday, May 17, 2011

It’s Crummy!

I’m talking about the current weather we’re dealing with. It has rained off and on for most of May, it seems. I feel especially bad for all of those people who live along the Mississippi River who have been displaced. May they be returned to their homes as soon as possible, and may the damage be minimal.

The semester is over. I didn’t think I’d be in a place where I could say that, but finals are done, all of the work has been turned in, and now it’s just the matter of waiting for grades. I can say – quite honestly, in fact – that it hasn’t been bad. I survived two semesters of General Chemistry (and managed to do quite well, all things considered), and I didn’t expect to like Psychology as much as I did. It’s not the first time I took it, however; I did it many years ago (right around 30, I think) and liked it then as well, but this time around seemed different. The instructor I had this time put more of a focus on the scientific aspects of the study of Psychology. He covered all of the material that was intended to be covered, but it was done in a systematic and orderly manner. In addition we had a really good group of people in the class. One of them is this young guy – I want to say he’s either 19 or 20 years old, not sure which – who struck me as being incredibly intelligent in a scary sort of way. He has a very high level of intellect and is quite articulate. And it was always interesting listening to him contribute to class discussion because he was just incredibly knowledgeable. I was impressed. Plus, there was one other “old guy” who was also quite intelligent. A forensic chemist who worked for the NH State Police Crime Lab for many years. And between the three of us as well as others, we were able to keep things interesting.

It’s safe to say that I really enjoyed it.

Now I’m putting together the application paperwork that I need for admission to the Biology program at UNH-Manchester. I have almost everything together, but I need to make arrangements for official transcripts from a boatload of schools. What a pain. But it shouldn’t be too too bad; I just have to make sure I get everything together in the next 10 days or so, and other than the transcripts I’m almost set to go.

Work has also been interesting lately. Last Thursday in town we had a couple of interesting situations. One of them involved a 91 year-old female in Congestive Heart Failure. Her son who was present didn’t think it was important to know that his mother had pronounced aortic stenosis as well as an ejection fraction of approximately 40%. Considering that in addition to having a fair amount of fluid in her lungs, she was hypotensive and tachycardic as well. The onset was acute, and she had no edema in her feet. She’d had an episode this past January that was much like this one. I don’t know how that one was treated, but with us she went directly on CPAP. That is first-line treatment for pre-hospital providers in New Hampshire, much like in many other places now, with medications (Nitro-Glycerin and Lasix, specifically) being second and third-line treatments. And considering her overall condition neither of those drugs would have been appropriate. Nitro is contra-indicated in a hypotensive patient, and Lasix would have affected her volume, also potentially affecting her pressure. So we figured it was wise to not put her in that position.

Now that I am free of the shackles of school, I hope I can write a little bit more, at least through the summer. I will do my best.


TOTWTYTR said...

Be careful with CPAP in hypotensive patients as it can make that worse. The Aortic Stenosis makes this much trickier to treat and it could well have been more cardiogenic shock than just CHF.

Some people recommend Dopamine for cases like this, but I've not had enough experience with it to say.

Walt Trachim said...

True enough about CPAP and hypotension - I can tell you that this was on my mind the whole time she was on board my ambulance. And I thought hard about the AS and how to deal with that, too. As it was, the CPAP turned out to be a good choice as it spun her condition around nicely; her apices were clear on arrival at the hospital. Bases were still a little wet but better. And she had color, which wasn't the case when we first got to her.

Hadn't thought of Dopamine. But if you think about mechanism (in the case of Cardiogenic Shock) it does make sense, once the volume issue is accounted for.