MCW Class of 2012

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Well, your aortic and pulmonic valves will sound the same, and for that matter, they often all sound the same. The thing is that when there is a murmur, you'll definitely hear it better in one or two places than in the other spots. Aortic stenosis isn't very noticeable over in the axilla, although occasionally you'll have a patient with a roaring murmur that you can even hear when you're listening to their back for respirations. Had one of those this month.
 
badasshairday said:
So I'm reviewing anatomy today, and I have a question about the heart. Kolesari made a point about the transverse sinus saying that a cardiac surgeon would wrap a finger/thumb around the aorta for...... something. Would you guys happen to know what that something is?

On a related note, I decided to try and hear my own valves, but it all sounds the same. 🙁
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Prolly just to sort of bluntly isolate the area where he or she would put an aorta clamp during a transplant. I don't know for sure though...I've not been involved in any cardiac surgeries.


You should try to hear the physiological splitting of S2 on yourself.
 
They clamp off the aortic root when they go on bypass and put a catheter in the transverse sinus.

I don't remember seeing a CT surgeon put his finger around the aorta just to do it though.
 
indo said:
Prolly just to sort of bluntly isolate the area where he or she would put an aorta clamp during a transplant. I don't know for sure though...I've not been involved in any cardiac surgeries.


You should try to hear the physiological splitting of S2 on yourself.
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I can't hear splitting on myself or my wife, even though I know what it sounds like (had a patient in August with very pronounced physiologic splitting).
 
TheProwler said:
I can't hear splitting on myself or my wife, even though I know what it sounds like (had a patient in August with very pronounced physiologic splitting).
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Oh, great.

Next you're going to tell them there's no such thing as a snipe hunt.

Keep listening, kids. You will HEAR THE S2 SPLIT IF YOU TRY HARD AND BELIEVE!
 
samenewme said:
Oh, great.

Next you're going to tell them there's no such thing as a snipe hunt.

Keep listening, kids. You will HEAR THE S2 SPLIT IF YOU TRY HARD AND BELIEVE!
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I can hear the S2 split, but then again, I'm a good doctor...




of funk.
 
I can usually catch my split S2 on inspiration when I self-auscultate.
 
So I've got to ask. How hectic is M3 year? I mean I know it is hectic. But how so? How much are you working on most days? How many days a month do you have off? How early do you wake up?
 
badasshairday said:
So I've got to ask. How hectic is M3 year? I mean I know it is hectic. But how so? How much are you working on most days? How many days a month do you have off? How early do you wake up?
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It depends on rotation. Generally 4-8 days off per month. Arrived at hospital/clinic as early as 4:30am, as late as 9am. If I'm not actively working on something in the hospital I try my damndest to get the heck outta there. Besides call, been there as late as 9pm. On some outpt months, it's a half day sometimes.



And I've never heard splitting. Except for when it was computer generated and slowed WAY down.
 
badasshairday said:
So I've got to ask. How hectic is M3 year? I mean I know it is hectic. But how so? How much are you working on most days? How many days a month do you have off? How early do you wake up?
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Agree with the above post. During inpatient months you can bank on only 4 days off for the month and approximately 10-12 hour days. Outpatient months generally have weekends off and are more 8 hour days with a few half-days thrown in.

One of the worst parts of the schedule aside from the early morning rounds (starting anywhere between 5 AM and 7 AM in my experience) has to be the unpredictability of which weekend days you have off. The majority of the time you are unaware of your call schedule until the first day of the rotation, which means that you are taking a risk anytime you make plans for a weekend more than a month in advance.

Granted you can request time off for things like weddings, but you had better have a good reason to go and you can't get away with doing things like that very often. They might also force you to make up clinical time missed in ways that are usually fairly painful.
 
Agree with the above posts, but when they say rounding at 5-7 that usually means team rounding start time (at least in my experience). That means the M3 gets there early to preround, depending on the rotation.
 
DoctorFunk said:
Agree with the above post. During inpatient months you can bank on only 4 days off for the month and approximately 10-12 hour days. Outpatient months generally have weekends off and are more 8 hour days with a few half-days thrown in.
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How many outpatient months do you do 3rd year? Also, I know in 3rd year there are core rotations through Family Med, Peds, Surgery, Medicine, and Psych(?), do you also have elective time in 3rd year? Or is that only in 4th year? And when they say Surgery, is it all general surgery? And when they say Medicine, is it general Internal medicine?

Have any of you guys rotated in cardiac surgery? I'm pretty sure I don't want to do surgery, but I really want to see cardiac surgery and learn a lot about it since heart issues are the #1 killer in this country. And for the same reason I want to do a rotation in Cards.

Basically as of right now, I'd want to do electives in Cards, Cardiac Surg, and Anesthesia. Is that possible? I know I'm thinking way ahead... still have to finish 1st year and 2nd year.
 
badasshairday said:
How many outpatient months do you do 3rd year? Also, I know in 3rd year there are core rotations through Family Med, Peds, Surgery, Medicine, and Psych(?), do you also have elective time in 3rd year? Or is that only in 4th year? And when they say Surgery, is it all general surgery? And when they say Medicine, is it general Internal medicine?

Have any of you guys rotated in cardiac surgery? I'm pretty sure I don't want to do surgery, but I really want to see cardiac surgery and learn a lot about it since heart issues are the #1 killer in this country. And for the same reason I want to do a rotation in Cards.

Basically as of right now, I'd want to do electives in Cards, Cardiac Surg, and Anesthesia. Is that possible? I know I'm thinking way ahead... still have to finish 1st year and 2nd year.
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You get 1 elective/vacation month M3 year. If you take an elective, you get 3 months of vacation M4 year. I highly recommend it.

The cores are: Psych/neuro, Ob/gyn, Family med, CPR (RPM/anesthesia/whatever/etc), and 2 months each of Surgery (1 gen surg month + 1 month gen surg subspecialty), Peds (1 month outpt + 1 month inpt), Medicine (2 inpt months, 1 inpt/1 outpt, 1 intpt/1 geriatric)

I did CT surgery at Froedtert and GS2 (gutts and butts at froedtert). So boring. I hate general surgery. Basically I didn't like getting up and going to work most of M3 year. The big 3 were horrible. Gen surg sucks. Internal medicine in painful, and peds... not a big fan of kids.

I liked ortho and anesthesia. FP was OK because I had it right after Ob/gyn, so it was a laid back month.

I did 2 inpatient months M3 year to avoid inpatient medicine as an M4 which is more intense -- cardiology is an option in that.

But really, you DON'T need to worry about this until February of your M2 year.
 
Ashers said:
I did 2 inpatient months M3 year to avoid inpatient medicine as an M4 which is more intense -- cardiology is an option in that.
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unless you have MICU at the VA as your inpatient medicine month. 0-2 pts at a time. Occasionally the team had no patients. We went for long lunches and one particularly beautiful day took a self-guided walking tour of the VA campus. But also, at the same time, I think I actually retained quite a bit of critical care learning. Maybe because I was generally happy.
 
When do we learn about tracts and such to choose for our third year? Hopefully I haven't missed it and it's already november!
 
badasshairday said:
I did laproscopic surgery today on a cadaver. It was badass. 🙂
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Sounds like fun...just wait until you have to drive the camera for an incompetent surgeon, though. Gave me flashbacks to back in the day when I would have to hold the flashlight while my dad worked under the hood of the car. "Goddamnit, pay attention to where I'm working, shine the light here!"
 
Gimlet said:
Sounds like fun...just wait until you have to drive the camera for an incompetent surgeon, though. Gave me flashbacks to back in the day when I would have to hold the flashlight while my dad worked under the hood of the car. "Goddamnit, pay attention to where I'm working, shine the light here!"
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Isn't driving the camera more fun then holding a retracter?
 
badasshairday said:
Isn't driving the camera more fun then holding a retracter?
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Oh heck no; it's absolutely horrible. I was so nervous the 2nd out of 2 times I had to drive a camera after being yelled at the whole time that I locked my knees and nearly passed out, which at least got me out of driving the camera for the rest of the case.

You get yelled at if you don't follow the surgeon exactly, if the camera moves when it isn't supposed to, and if crap gets on the lens.
 
Ashers said:
Oh heck no; it's absolutely horrible. I was so nervous the 2nd out of 2 times I had to drive a camera after being yelled at the whole time that I locked my knees and nearly passed out, which at least got me out of driving the camera for the rest of the case.

You get yelled at if you don't follow the surgeon exactly, if the camera moves when it isn't supposed to, and if crap gets on the lens.
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Damn. I wish I knew this earlier, so I would of played with the camera more! The cadaver we did this on was fresh and very lightly embalmed so it was like real. A GSurg Resident was showing us how to work the stuff. But since it was lightly embalmed, I think they won't have it next week. I'm screwed 3rd year. 🙁
 
badasshairday said:
Damn. I wish I knew this earlier, so I would of played with the camera more! The cadaver we did this on was fresh and very lightly embalmed so it was like real. A GSurg Resident was showing us how to work the stuff. But since it was lightly embalmed, I think they won't have it next week. I'm screwed 3rd year. 🙁
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Not that you would remember how to do that M3 year. And anytime you're in a long surgery, you're going make the camera dive. If you shift feet positions the camera moves. Don't worry about it. I only had to scrub for 2 laproscopic surgeries during my 2 months of surgery.

They weren't nearly the worst thing about that rotation. I hate gen surg.
 
badasshairday said:
Damn. I wish I knew this earlier, so I would of played with the camera more! The cadaver we did this on was fresh and very lightly embalmed so it was like real. A GSurg Resident was showing us how to work the stuff. But since it was lightly embalmed, I think they won't have it next week. I'm screwed 3rd year. 🙁
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it's not that hard. the only thing is that some people have different preferences, and they'll always razz you for shaking it just a little.
 
badasshairday said:
I dunno, but playing with the laproscopic stuff made me think about going into surgery. 😱

It was fun... like playing video games.
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Some people like it. I don't like the anatomy. I don't like it that people are sick.

I like powertools, and the occasional arthoscopic thing, but there's less room for the camera to wiggle around.
 
You know how when you listen to a beating heart, it goes Lub Dub... Is the dub part the sound of the pulmonary and aortic valves closing?
 
Crap. Degradation of amino acids + synthesis of non-essential amino acids and amino acid derived molecules = Insanity.
 
does anyone know how to get the calendar the school gave us into ical for the mac?
 
Kernal83 said:
does anyone know how to get the calendar the school gave us into ical for the mac?
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pretty sure it's just a PDF file, so I suspect the best (only) way is to painstakingly hand type them all in. Sounds like an awesome thing to do on a rainy day.
 
Kernal83 said:
does anyone know how to get the calendar the school gave us into ical for the mac?
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there used to be an "Add to Outlook" button that would put stuff in your calendar. if they don't have it, I'd ask if they could put it back.
 
Finished block 3 and I'm going back to California next Saturday for Thanksgiving. Though this would be appropriate: I'm going going back back to Cali Cali.

[youtube]http://www.youtube.com/watch?v=9cGs4308jkA&feature=related[/youtube]
 
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is it true you guys are now required to show up to all lectures given by MDs, and you have to wear your white coats? One of the M2s said you do.
 
Only for those Biochem clinical correlations lectures, otherwise I still skip classes including Devo and Anatomy even when we have guest MD lecturers because it isn't required.

For the biochem clinical correlations lectures they said it was mandatory and they take attendence, plus we HAVE to wear our white coats or they don't let us in. At first they didn't care what we wore underneath, so a lot of people came with a T-shirt and jeans under their white coat... then one of my classmates said that we should probably dress better... so now they require that to. lol.
 
badasshairday said:
For the biochem clinical correlations lectures they said it was mandatory and they take attendence, plus we HAVE to wear our white coats or they don't let us in.
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I'm so glad I'm not dealing with that. I'm SO glad I'm almost graduated.
 
badasshairday said:
Only for those Biochem clinical correlations lectures, otherwise I still skip classes including Devo and Anatomy even when we have guest MD lecturers because it isn't required.

For the biochem clinical correlations lectures they said it was mandatory and they take attendence, plus we HAVE to wear our white coats or they don't let us in. At first they didn't care what we wore underneath, so a lot of people came with a T-shirt and jeans under their white coat... then one of my classmates said that we should probably dress better... so now they require that to. lol.
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I heard that Sabina saw it at another school and thought it was a great idea. I wish he'd see someone with a nice haircut and think that was a great idea.
 
badasshairday said:
Only for those Biochem clinical correlations lectures, otherwise I still skip classes including Devo and Anatomy even when we have guest MD lecturers because it isn't required.

For the biochem clinical correlations lectures they said it was mandatory and they take attendence, plus we HAVE to wear our white coats or they don't let us in. At first they didn't care what we wore underneath, so a lot of people came with a T-shirt and jeans under their white coat... then one of my classmates said that we should probably dress better... so now they require that to. lol.
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what in the hell is the point? We don't even always wear our white coats during conferences 3rd and 4th year. No one slaps your hand if you take it off.
 
akpete said:
what in the hell is the point? We don't even always wear our white coats during conferences 3rd and 4th year. No one slaps your hand if you take it off.
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For real...the only time it should ever be mandatory to wear a white coat is if you are going to have direct patient contact. I pretty much ditch mine as soon as I know I won't be seeing patients.
 
Gimlet said:
For real...the only time it should ever be mandatory to wear a white coat is if you are going to have direct patient contact. I pretty much ditch mine as soon as I know I won't be seeing patients.
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really? I ditch mine even when I DO see patients. hate that freaking thing.
 
Gimlet said:
For real...the only time it should ever be mandatory to wear a white coat is if you are going to have direct patient contact. I pretty much ditch mine as soon as I know I won't be seeing patients.
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one of our peds interns never wears his white coat - he says that's why he went into peds. I haven't seen him wear it yet.
 
DoctorFunk said:
Yeah, just wait until Nationalized Healthcare gets a load of that.
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Obamunism is on its way. Even CRNAs can pull over $200K in some cities.


Of course, we could also save a lot of money if we had just a few realistic discussions with family members on why their loved one could just die in peace with some narcotics rather than a futile full-court press with transplants, ventilators, TPN, G-tubes, two dozen specialist consults, and zero quality of life. We have a few patients on our floor who are in similar situations, bad enough that one of the primary docs of one of these patients said "I wish s/he were dead."
 
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