Hyperarousal

A lecturer this term stated that, physiologically speaking, you can only maintain an adrenaline-fuelled state of hyperarousal for about 60 minutes. This was disputed by some of the ex-soldiers in my class, but I guess for civvies like myself, it sounds about right.

I held tightly onto this when the OSCE's came around. Written exams never provoke the same level of sympathetic response in me. It's not because they're a "you know it or you don't" event so much as they're a "sit on your arse and only move your hand event".

OSCEs by comparison are a full-systems-go-hello-my-name-is experience with actors or simulated patients and an individual examiner. OSCE stands for Objective Structured Clinical Examination and is just that. There is a task to be completed. You're running through mental check lists: Look, Feel, Percuss, Auscultate if it's something like a cardio exam or Passive, Active, Resisted when you're examining someone's wrist and elbow or even the classic History of Presenting Complaint, Medical History, Family, Social, Medications, Allergies when you're taking a history. You stand outside a cubicle, a buzzer rings, you read your handout, figure out which checklist you're going to need, memorise the patient's name, another buzzer rings and you're in.

You learn to introduce and consent in roughly ten seconds. Maybe 20 if you need to explain a more intimate exam. You're gently smiling, making the right amount of eye contact and trying to remember the first point of call on your checklist.

Checklists beget checklists beget checklists. Remember where you are. Comment on what you don't see. You can't be negatively marked so call out everything. Start at the hands, don't miss the capillary refill.

I sat in the one of my uni's many coffeeshops with my course buddy CRM and we listed 10 things to look for in the hands alone. Just call them out, you're bound to hit most of the ones you need for this specific exam. And anyway, in real life, you'd be looking for everything anyway, not just the finger clubbing of respiratory issues or the leuconychia of hepatic problems.

So back to my lecturers comment. when I turn up to uni before the exam, I sit on my adrenal response. Lots of revision of my checklists, not thinking about the exam. Drink me some coffee, try a little synthetic stimulant replacement. About 30 minutes before the exam, I imagine what it must feel like to stand at the door of a plane in the sky, about to do a parachute jump.

And Woosh

There it is.

At my word, unleash catecholamines.

Energy, alertness, fine tremor, my sympathetic response. My ancestors used this to run from wolves, I use this to stay focussed on a simulation of real life for 50 minutes. Which, incidentally, really doesn't feel that long when you're doing it.

But it's over for another year (god willing and I don't have resits).

I didn't have to revise anything today. It felt amazing.

So, Google+

So I finished my Musculo-skeletal exam this morning and came home to find a Google+ invite in my inbox. It's pretty neat and I can see me enjoying using it more than Facebook - if my cadre of friends get involved.

However.

If you add people who aren't on Google+ yet to a group and post a message to your profile that they can see, Google+ offers to send them an email. Useful right? Not so much if you've lumped everyone together and you say something which your friends might find funny, but your parents/ in-laws not so much

At first I was like

But then I was like

I've spent the last 4 hours furiously revising clinical skills. And will be doing that tomorrow. And Sunday. So whatever. Ask me about finger clubbing and spider naevi and sub-acromial bursitis.

I dare you.

The Checklist

Dr Steven Novella has just done a nice post on the importance of Checklists in general. I was introduced to the notion of the WHO's surgical checklist by one of my lecturers (I forget the main thrust of her lecture) who wanted to emphasise how lives are saved by double- and triple-checking aspects of care. When we did a mock OSCE on Tuesday one of the stations was drug administration, something I've been schooled in for quite a while and it gave me chance to share one of the checklist tools I was given in my nursing training:

The 5 rights of drug administration
Right patient
Right drug
Right time
Right route
Right dose

I've seen plenty of corners cut in my time on the wards, and how it was down to people doing extra work that there weren't serious complications. I hope I don't forget this when it's my turn to do either the right thing or the easy thing. I don't think they're often the same thing.

Why does my heart, feel so bad?

Actually it doesn't. But I thought of that title for this post and couldn't come up with a better one.

Clinical skills this week was ECGs, which I have done hundreds of times as a nurse, not really understanding what I'm looking for, sticking the dots on, pressing go and calling the doctor. I know what a QRS complex should look like and that lead II is my rhythm strip but that's about it.

To be honest at this stage of med school, we're not expected to know much more than that, but we have been given a bit more knowledge and explanation for what we should expect to see on which lead. It feels great to have a little bit less mystery in my world and a bit more knowledge that I can apply. I'm sure it will take the remainder of my course to really get to grips with ECG's, but I'm happy that I've understood everything they've explained so far.

yup, I think I'll live

I've been told that ECG's and CXr's are the hardest things to analyse, but the most useful. So I guess I might spend a bit extra time with this, even if it's not going to be an OSCE station, I think the clincal application warrants it.

(P.S. Anyone else see a bit of the old exercise-induced left ventricular hypertrophy? :P)