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Archive for April 13th, 2008

Gross Anatomy Advice

Posted by medliorator on April 13, 2008

Panda Bear, MD recollects his pre-clinical years:

Dissecting can be difficult and, particularly for delicate structures like nerves and small blood vessels, can also be extremely frustrating. Imagine trying to pick through a piece of chicken or roast beef looking for something the size of a thread. That’s what a lot of your time will be spent doing.

You want to avoid using a scalpel for this as much as possible because it tends to cut across planes and distort anatomy. Blunt dissection with your fingers or a small instrument is the preferred method.

I didn’t like anatomy lab very much so I spent as little time as possible there. …I was tired of picking at the damn things and smelling like embalming fluid.

I did very well on all the tests however because I had a good photographic atlas that showed perfectly dissected specimens. Gross Anatomy tests, you understand, are “practicals” where you circulate through the lab from tank to tank, identifying tagged structures on other people’s cadavers. The instructors looked for well-dissected structures that usually looked almost exactly like those in the atlas. If they couldn’t find a good example they dissected one themselves. So you see, my photographic atlas was like anatomy lab without the bad smell.

I did better on the practicals than many people who came in on their own time, after hours and on the weekends, to dissect. You are certainly allowed and even encouraged to spend as much time in lab as you want.

Get some cheap scrubs to wear in lab. We were not allowed to wear street clothes in our lab but even if you are resist the temptation unless you don’t mind throwing them away. I discarded all of my gross lab scrubs when I decided to stop going as well as my shoes.

get an anatomy atlas to keep in the lab as well as a “dissector,” the book that gives instructions for dissection. We kept ours in a plastic bag in the tank on top of the cadaver. The reason for this should be obvious. Do you really want to study on your kitchen table with a book that is soaked in corpse juice and may have small bits of human flesh stuck to it?

Get a turkey baster. …there is nothing better for draining fluid out of body cavities and it beats rolling the body to drain it.

Medical School Pre-Clinical Years: Twenty Questions (Part 2) [Panda Bear, MD]

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Teach Patients to Count Carbs

Posted by medliorator on April 13, 2008

Using a 10-step guide called C-O-U-N-T C-A-R-B-S.

1. Create a typical meal. The nurse is supposed to talk through the details of an ordinary meal the patient eats on a regular basis, including sauces, condiments, and beverages.

2. Offer information. Here the nurse defines carbohydrate, and explains which foods from the previous step contain them.

3. Use food lists and labels. A quick lesson in reading food packaging labels, including paying close attention to Serving Size, and the idea of 15-carb “units.”

4. Now it’s the patient’s turn. The patient is next asked to try to estimate the total carb value of their typical meal in Step 1.

5. Take time. “Answer questions and provide clarification and performance feedback.”

6. Compare patient choices to written dietitian recommendations. The nurse is encouraged to be constructive and focus on the positive.

7. Adjust meal. Talk about ways to alter meal choices based on dietitian recommendations. Here’s where the nurse can use “visualization” for portion sizes, etc.

8. Recalculate, record, reinforce. The patient gets to recalculate their initial meal as a sample entry in a food diary. The nurse demonstrates how to record BG readings and insulin doses. Learning is reinforced using “case scenarios.”

9. Bolus. the nurse is supposed to assist with administering an appropriate bolus.

10. Support learning. provide resources for the patient to consult later on, like web sites, support groups, and customized food lists based on the patient’s preferences.

Teaching Patients to Carb-Count [Diabetes Mine]

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