Thursday, May 3, 2012
Wednesday, May 2, 2012
Emedinews:Insights on Medicoleagl Issues:Sudden death due to cardiac origin–autopsy
Right coronary artery supplies blood to
electrical area of heart
The most common cause of sudden cardiac
death in adults over the age of 40 has been coronary artery atheroma seen in postmortem
examination in about 100 cases randomly selected by me in AIIMS mortuary.
- The most common finding at postmortem examination is
chronic high–grade stenosis of minimum one segment of a major coronary
artery, the arteries which supply the heart muscle with its blood supply.
- A significant number of cases also have an identifiable
clot in a major coronary artery which causes transmural occlusion of that
vessel.
- In 75 cases out of hundreds, the clots were seen in
right coronary artery supplying the electrical area of heart.
- Death in these cases is thought to result from a period
of transient or prolonged lack of blood supply in the muscle of the heart
wall, which induces an ventricular arrhythmia/fibrillation and no changes
in the myocardium is seen during postmortem examination.
- The absence of histological signs of acute necrosis and
a healed infarct are a common finding.
- Chronic high–grade stenosis causing previous episodes
of ischemia and areas of focal fibrosis is seen histologically in the
myocardium.
- Ventricular arrhythmias may arise from a myocardium
which has been previously scarred by episodes of ischemia.
Emedinews:Makesure:A patient intolerant to penicillin was denied rheumatic prophylaxis.
Situation:
A patient intolerant to penicillin was denied rheumatic prophylaxis.
Reaction: Oh my God! Why was he not put on a sulfa drug?
Lesson: Make sure that patients who cannot tolerate penicillin are put on sulfadiazine or sulfisoxazole. This antibiotic class is effective for preventing group A streptococcal (GAS) infection although it cannot be used to achieve eradication.
Reaction: Oh my God! Why was he not put on a sulfa drug?
Lesson: Make sure that patients who cannot tolerate penicillin are put on sulfadiazine or sulfisoxazole. This antibiotic class is effective for preventing group A streptococcal (GAS) infection although it cannot be used to achieve eradication.
Emedinews:Inspiration:A lesson for a lifetime
When I
arrived at 6 a.m. in the large hospital kitchen, Rose was already checking name
tags on the trays against the patient roster. Stainless steel shelves held rows
of breakfast trays which we would soon be serving.
"Hi,
I'm Janet." I tried to sound cheerful, although I already knew Rose's
reputation for being impossible to work with. "I'm scheduled to work with
you this week."
Rose, a
middle-aged woman with graying hair, stopped what she was doing and peered over
her reading glasses. I could tell from her expression she wasn't pleased to see
a student worker. "What do you want me to do? Start the coffee?" Rose
sullenly nodded and went back to checking name tags.
I filled the
40-cup pot with cold water and began making the coffee when Rose gruffly
snapped, "That's not the way to make coffee." She stepped in and took
over. "I was just doing it the way our supervisor showed us to do
it," I said in astonishment. "The patients like the coffee better the
way I do it," she replied curtly.
Nothing I
did pleased her. All morning her eagle eyes missed nothing and her sharp words
stung. She literally trailed me around the kitchen. Later, after breakfast had
been served and the dishes had been washed, I set up my share of trays for the
next meal. Then I busied myself cleaning the sink. Certainly Rose couldn't
criticize the way I did that.
When I
turned around, there stood Rose, rearranging all of the trays I had just set
up! Totally exhausted, I trudged the six blocks home from the University of
Minnesota Hospital late that June afternoon. As a third year university student
working my way through school, I had never before encountered anyone like Rose.
Fighting
back tears, I wrestled with my dilemma alone in my room. "Lord, what do
you want me to do? I can't take much more of Rose." I turned the
possibilities over in my mind. Should I see if my supervisor would switch me to
work with someone else? Scheduling was fairly flexible. On the other hand, I
didn't want to be a quitter. I knew my older co-workers were watching to see if
my actions matched my words.
The answer
to my prayer caught me completely by surprise -- I needed to love Rose. Love
her? No way! Tolerate, yes, but loving her was impossible. "Lord, I can't
love Rose. You'll have to do it through me."
Working with
Rose the next morning, I ignored the barbs thrown in my direction and did
things Rose's way as much as possible to avoid friction. As I worked, I
silently began to surround Rose with a warm blanket of prayers. "Lord,
help me love Rose. Lord, bless Rose."
Over the
next few days an amazing thing began to happen. As I prayed for this irritating
woman, my focus shifted from what she was doing to me, and I started seeing
Rose as the hurting person she was. The icy tension began to melt away.
Throughout
the rest of the summer, we had numerous opportunities to work together. Each
time she seemed genuinely happy to see me. As I worked with this lonely woman,
I listened to her--something no one else had done. I learned that she was
burdened by elderly parents who needed her care, her own health problems, and
an alcoholic husband she was thinking of leaving.
The days
slipped by quickly as I finished the last several weeks of my summer job.
Leaves were starting to turn yellow and red, and there was a cool, crispness in
the air. I soon would be returning as a full-time university student. One day,
while I was working alone in one of the hospital kitchens, Rose entered the
room. Instead of her blue uniform, she was wearing street clothes.
I looked at
her in surprise. "Aren't you working today?" "I got me another
job and won't be working here no more," she said as she walked over and
gave me a quick hug. "I just came to say good-bye." Then she turned
abruptly and walked out the door.
Although I
never saw Rose again, I still remember her vividly. That summer I learned a
lesson I've never forgotten. The world is full of people like Rose - irritating,
demanding, unlovable - yet hurting inside. I've found that love is the best way
to turn an enemy into a friend.
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