DundeeChest 3.0

Archive for the ‘blogging’ Category

Death in a bun. Tasty, tasty death....

No I’m not a militant vegetarian, I wouldn’t be able to cope with all the hemp and Tofu. I just love the eye-catching nature of this piece from a consumer health blog about choking hazards – “About 17 percent of food-related asphyxiations were caused by hot dogs.” Despite the original press release from the American Academy of Pediatrics mentioning nary a word about processed pig snouts being the biggest killer since smallpox, there has apparently been a move to redesign the hotdog. As one statement author Gary Smith put it, “If you were to take the best engineers in the world and try to design the perfect plug for a child’s airway, it would be a hot dog,” One could only assume they would be working for Dr. Evil in this task.

Perhaps we simply need to encourage increased use of condiment lubrication and practice  our skills at removing these pig fingers from the right main bronchus? If nothing else, I’m sure our great british press will be able to torture this information into assuring us that Cumberland rings are better for your health.

“If meat is murder, is Quorn just wasting police time?” Armando Iannucci

As DundeeChest gets older, he needs more and more sleep. I remember being able to get by on 4 to 6 hours a night, and feeling great on it. Now I need 8 hours minimum, and realistically 10 hours to really function well. A really late night (after midnight) puts me off kilter for days.

See this post to see why I need so much sleep these days…

Cross posted from my Doc-2-Doc blog.

I did a post take ward round on Monday. The usual mixture of general medicine, with little to excite the respiratory physician. A student commented that I had reviewed a whole bay of patients without the need for a stethoscope. This got me thinking – has the ancient art of auscultation died with my generation of physicians?

Does it matter if we can tell the difference between various murmurs when a portable echo can give us not only qualitative, but quantitative information with one bedside test. We hear fine crackles, an echo an an HRCT tell us what we need to know. 25 years ago our cardiologists taught us how to determine reverse splitting of the second heart sound, and to judge the severity of mitral stenosis from the delay before the opening snap. When was the last time you relied on that kind of clinical finding? Last month I saw a patient with a 5 cm pericardial effusion; there was no clinical indication of that diagnosis at all.
So what’s the point of all this? A senior colleague of mine has long said we should stop teaching our students auscultation, and teach them all bedside ultrasound rom an early stage. I have to agree with him about the ultrasound: we should be definitely be teaching these skills, and I have started teaching all our registrars, and ST grades the basics of thoracic ultrasound. But should we throw away our ‘tubes’? I don’t think so.
Rene Laennec invented the stethoscope on 1816, and it has served us well for nearly 200 years. Although the echocardiogram may have made listening to heard sounds “so last century”, there’s no test to detect bronchospasm, no scan to detect a pleural rub. So as chest physicians, we still need the ‘scope.

A non-physician friend of mine worked with HEMS in the 90’s – he tells me that the real reason we carry stethoscopes is for photo opportunities. What would Laennec say?

Thanks to everyone who made the effort to come along to the revision lecture on Wednesday – I appreciate that the week before the exams is a precious time, and two hours of me waving my arms about at the front of the class, being grumpy about hypoxic drive might not be your first choice of entertainment for Wednesday.

I have been told I was a little bit *too* grumpy, which is probably a fair piece of feedback – I was disappointed that the issues of Respiratory Failure, CO2 retention, and oxygen therapy remain the biggest stumbling blocks for you all, despite me having put in a lot of personal effort to explain these concepts to you all during the respiratory block.

After the lecture I taught a small group of 4th years on arterial blood gas analysis and respiratory failure. A small number of 2nd years tagged along (This is hugely rewarding for me, that 2nd years want to join in with 4th year teaching, so thanks) and it was during this session that I think I’m expecting too much regarding the respiratory failure, hypoxic drive issues: the 4th years have no more grasp of the concepts than the 2nd years. These *are* difficult concepts, and it is likely that the lack of understanding is due to poor teaching, rather than a global misunderstanding on the students part.

This has made me think about how I have been teaching these concepts. i have posted on DC1 and DC3.0 the definitions and explanations of the concepts of both CO2 retention in hypoventilatory states, the concepts of V/Q mismatch, and respiratory failure a couple of times, and each time I’ve tried to make them more understandable, and more straightfoward. I have had little feedback from the students regarding these posts. The videos are helpful, I’m sure, but the students are not getting it.

We have opportunities for students to do fellowships, SSCs, 4th year projects, and extra curricular work developing new learning materials, if anyone is interested.

So the revision lecture on Wednesday? My initial thoughts were of disappointment, and a small amount of despair. When I heard the feedback from a student that I was grumpy during the session, it has made me think more about not just the lecture, but how we teach these difficult concepts. Now? I’m hopeful that someone out there is encouraged enough to come to see me with an idea for a way to teach these topics in a more engaging way.

And I’m allowed to be grumpy occasionally – 365 days a year of manic enthusiasm takes it out on a person, even me!