Push yourself, because no one else is going to do it for you.
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Medical School Resources! (and other human biology,physiology,biochemistry-related resources)
Hi Everyone!
Update: I am now officially done with my second year! I know i’ve been MIA on here for a while now - but that’s only because I was drowning in textbooks and assignments! I will be writing a whole other post on what my second year in medical school was like - so watch out for that :)
I, for one, can not just rely on one method of learning. Meaning, I’ll jump from videos, to textbooks, to flashcards. In this post I’m going to list some of my holy grail youtube channels that have helped saved me.
1) Handwritten Tutorials
https://www.youtube.com/user/harpinmartin
Every video in this channel is short, but not so much that you feel like you’re missing out on information. Definitely one to save as a favourite!
2) Armando Hasudungan
https://www.youtube.com/user/armandohasudungan
The best thing about this channel is the fact that there are over 300 videos, covering a wide range of core topics in endocrinology, neurology, physiology and pharmacology. Another pro is the presentation of topics (otherwise considered snooze-worthy) in an artistic manner!
3) Speed Pharmacology
https://www.youtube.com/channel/UC-i2EBYXH6-GAglvuDIaufQ
Raise your hand if you’ve ever fallen asleep trying to read about the mechanism of action of opioids, their side effects and contraindications. I know I have. Fret not, for this youtube channel will introduce you to a world where pharmacology is actually interesting.
4) Wendy Riggs
https://www.youtube.com/user/wendogg1
Wendy Riggs is a very down-to-earth professor in Northern California, and she covers a wide range of topics in Anatomy, Physiology and General Biology.
5) Anatomy Zone
https://www.youtube.com/user/TheAnatomyZone
A better way to learn anatomy is to supplement your textbook information with videos from this channel. The explanations and visuals provided are absolute gold.
I hope you all find these channels as helpful as I did!
Anti-epileptics/Anti-convulsants Made Incredibly Easy
TREATMENT STRATEGIES:
Start therapy after the second seizure; first ONLY if recurrence is high = MRI abnormal, EEG abnormal, or status epilepticus.
Monotherapy until seizures are controlled.
If failed: titrate up to maximum tolerated dose –> shift to alternative drug –> use drug combination –> VNS, DBS.
Full drug therapy for 2 – 3 years after the last fit.
Gradual withdrawal over at least 6 months.
Rx Profile:
(Drawings are courtesy of @mynotes4usmle)
Carbamazepine
Mainly for generalized tonic-clonic seizures
Trigeminal neuralgia
Bipolar disorders (with depressive predomince) - mood stabelizier
NEVER in abscence seizures
SE:
Lamotrigine
Safer profile, with minimal interactions.
Bipolar disorders (with depressive predominance) - mood stabilizer
SE: maculopapular rash; SJS
Topiramate
Broad spectrum anti-seizure; used in migraine.
SE of TopIRamate: enzyme Inhibitor + Renal stones.
TREATMENT PROTOCOL:
Green: first line; Yellow: second line; Orange: third line; Red: contraindications. (Graph reproduced from Oxford Handbook of Clinical Medicine)
Epilepsy & Pregnancy:
Non-enzyme-inducing AEDS have no effect on the pill. Enzyme inhibitors prolong the half life of OCP (=Valproate) so better for birth control , and vice versa.
Most of AEDs are teratogenic; Category D
Therapy not stopped; uncontrolled seizure is risky to fetus & mother. Give lowest effective dose.
Avoid phenytoin, valproate and barbiturates (use Lamotrigine)
Most AEDs cause folate deficiency …. Folic acid (prior to or early in conception)
Most AEDs are competitive inhibitors of vit. K-dependent clotting factor: Vit. K to mother 10 days before labor & to newborn.
Most except carbamazepine and valproate are present in breast milk. Lamotrigine is safe on infants.
Status Epilepticus:
WHAT? Seizures lasting for >30min, OR repeated seizures without intervening consciousness.
Things to be done:
Bedside glucose, the following tests can be done once Rx has started: lab glucose, ABG, U&E, Ca2+, FBC, ECG.
Consider anticonvulsant levels, toxicology screen, LP, cultures, EEG, CT, CO level.
Pulse oximetry, cardiac monitor.
How to treat?
THE END
If someone has an 'enhanced metabolism' that processes drugs faster, is it easier or harder for them to overdose? Wouldn't they uptake more of a drug quicker, therefor making it more dangerous? I see this a lot with Captain America and Spider-man and such, where the dose of various medicines will be raised and I'm not sure that makes sense?
…oooooh you sure have opened a can of pharmacokinetic worms here….
Simply put, whether the drug never reaches therapeutic blood levels, or exceeds them, depends on 1) how the character’s metabolism works, and 2) what kind of drug they ingested (skip to the bolded part at the end of the post to get the tl;dr).
When you take a drug, the following happens (this process is sometimes denoted as “ADME” or “LADME”:
The drug must separate from the vehicle that brought it into the body (for example, a pill must disintegrate in the stomach, releasing the drug, or an IM or IV drug must separate from its solution): Liberation
The drug must be absorbed into the bloodstream (for a pill this would mean getting absorbed through the lining of the stomach or intestine, for IM injections this means getting absorbed by blood vessels running through the muscle where the drug is): Absorption
The drug must be deposited from the bloodstream into a location where it can be used: Distribution
The drug must be metabolized (broken down or changed by a biologic process, creating different chemicals called metabolites): Metabolism
The drug metabolites must be excreted from the body: Elimination
The first end of this process is largely driven by regular old chemistry. A pill has to dissolve to release the drug, and assuming that these characters have similar stomach/small intestine environments, this is not going to be different for them.
Absorption is mostly driven by a concentration gradient (substances like to be at the same concentration across membranes, so if there’s more drug in the small intestine than there is in the blood around the small intestine, the drug gets absorbed into the blood as the concentrations try to equalize), so this too is probably not going to be all that different. Even distribution is (mostly) driven by that concentration gradient, so, again, this process wouldn’t necessarily be any different from that of a normal human.
Now, the latter half of this process is a lot more dependent on a person’s specific physiology. When we talk about metabolism, we’re talking about how the body changes ingested chemicals into something excrete-able. For many drugs, this change involves enzymes in the liver.
About 6 different liver enzymes are responsible for the metabolism of about 90% of drugs. Each different enzyme is responsible for the breakdown of a different group of drugs.
Some people have genetic mutations that cause more or less of an enzyme to be produced. People who make more of an enzyme metabolize that group of drugs faster, while people who make less of them metabolize those drugs more slowly.
Through certain genetic tests, real life people can be designated one of the following for any given group of drugs:
Ultrarapid Metabolizers have the genetic wiring to produce way, way more copies of an enzyme than the typical person, and metabolize the corresponding drugs very, very quickly
Extentive Metabolizers produce more copies of the enzyme than most people
Intermediate Metabolizers produce an average number of copies
Poor Metabolizers produce significantly fewer copies than average, leaving them unable to metabolize the drugs normally
Now, remember how I said it also has to do with what kind of drug it is? There are two different kinds of drugs I’m talking about: Active Drugs and Prodrugs. Active drugs are able to be used by the body as-is. Prodrugs only have an effect once they’ve been metabolized by the body into a different substance.
Say someone is an ultrarapid metabolizer of an active drug. They take the drug, it gets absorbed and distributed like normal, but they rapidly metabolize it into inactive substances and excrete it. This person would either get no effect from a typical dose, or only a very slight one, because the drug is never allowed to build up to effective levels in their blood before getting metabolized.
But say that same person is a poor metabolizer of a different active drug. They take the drug, it gets absorbed, but they only very slowly are able to metabolize and excrete it. The drug ends up building up in their blood and staying there longer, possibly causing an overdose of the drug at a typical dose.
The situation would be reversed if the drugs were prodrugs instead. An ultrarapid metabolizer of a prodrug ends up metabolizing too much of the active substance too quickly, possibly causing overdose, while a poor metabolizer of a prodrug maybe never metabolize enough to get effective concentrations of the end substance (check out this post on the prodrug codeine).
Finally, applying this real-life precedent to Captain America, or Flash, or Spider-Man canon evidence, you would have to assume that due to their respective super powers, they all produce a metric sh*tton of liver enzymes capable of metabolizing drugs super fast and hella effective kidneys for excreting them. Typical doses of active drugs would barely work on them, while prodrugs might have a short, but incredibly strong effect on them.
R E F E R E N C E S
Quantitative Structure-Activity Relationship (QSARs) - Drug Development
QSAR modelling predicts the biological activity of a compound based off its physical properties. They are used to avoid synthesising and testing every possible version of a molecule to find the optimum for bioactivity. A small number of structurally similar molecules are synthesised and tested, and these results are used to mathematically predict other similar molecules on a computer.
Hydrophobicity
This dictates the ease at which a molecule will pass through a cell membrane. Too hydrophobic and the molecule will be drawn to lipids and its bioactivity will be reduced, too hydrophilic and the molecule will be too polar to pass through the phospholipid bilayer and will not carry out its desired activity (will be excreted in urine)
LogP - a measure of the whole molecule’s hydrophobicity
High logP = more hydrophobic
Low logP = more hydrophillic (polar)
Optimum for bioavailibility = 2-4.5
A regression equation can be formed with c=concentration for max activity
1/c = K1 logP + k2
If linear, values for other similar structures can be taken off the line. If parabolic = logP^2, indicating that after a max concentration bioavalibility will not increase as the drug becomes too hydrophobic and moves into fats.
Substituent hydrophobicity constant, π
Measures the hydrophobicity of individual substituents in a compound.
π = logPX - logPH
X= partition coefficient for substituted compound
H= partition coefficient for unsubstituted compound (Hydrogen (so if H was in place of the substituent of interest))
Compares how hydrophobic a substituent is compared to hydrogen
π = +ve –> X= more hydrophobic than hydrogen
π = -ve –> X= less hydrophobic than hydrogen
Note: can be used to calculate logP by adding substituents, rather than having to synthesise and test the molecule (clogP = calculated logP)
Electronics
Pharmacokinetics (administration, distribution, metabolism and excretion) rarely depends on hydrophobicity alone. The polarity of a compound dictates its passage through the patient and its binding at point of activity.
Hammett substituent constant, σ
The starting point is a chemical equilibrium for which both the substituent constant and the reaction constant are arbitrarily set to 1: the ionization of benzoic acid (R and R’ both H) in water at 25 °C.
Provides K0.
RCO2H <–> RCO2- + H+
uses the dissociation constant
kH = [RCO2-][H+] / [RCO2H]
If X is electron withdrawing, it will stabilise RCO2- and shift the equilibrium to the right. kX will increase
eg NO2, CN, Cl –> +ve σ
If X is electron donating, it will destabilise the RCO2- anion and shift equilibrium to the left, with a drop in kX.
eg alkyls, ethyls, methyls = -ve σ
σ = logkX - logkH
Steric properties
Taft steric parameter, Es = rate of hydrolysis of XCH2CO2Me under acidic conditions
Es = logkX - logKH
If X is physically small, the rate of hydrolysis (time taken to reach tetrahedral intermediate) will be fast.
Here, the size of R affects the rate of reaction by blocking nucleophilic attack by water.
H 1.24 +ve value: little steric resistance to hydrolysis Me 0.00 the reference substituent in the Taft equation t-Bu -2.78 -ve value: large resistance to hydrolysis
Small X = large Es, large X = small Es
Accuracy of calculation decreases as the bulk and length of the chain increases.
Hansch equations put several of the parameters together to compare overall bioavailibility of different compounds.
Craig plots
Plots 2 constants
functional groups with similar activity will be in the same quadrant
the optimum quadrant, eg +ve σ and -ve π, will contain all the substituents worth investigating
PHARMACOKINETICS CALCULATIONS
Single-Dose: •Vd = Dose/Co •t1/2 = 0.7 x Vd/Cl
Multiple-Dose, Infusions: •Ko = Cl x Css •LD = Vd x Cp/f •MD = Cl x Css x dosing interval/f
Vd: volume of distribution Co: plasma [ ] at zero time Cp: plasma [ ] t1/2: half life Cl: clearance = free fraction x GFR Ko: infusion rate Css: steady state [ ] LD: loading dose MD: maintaining dose f: bioavailability
Pharmacokinetics Overview
(Absorption and distribution of drugs)
The study of the time course of drugs and their metabolites in the body (what the body does to the drug) consisting of:
administration
absorption
distribution
metabolism
excretion
Administration
Enteral (passes through intestine)
oral (mouth)
buccal/sublingual (applied in cheek/under tongue)
Gastrosomy (surgical opening through the abdomen into the stomach)
Topical (applied directly)
Nasal
Rectal
Ophthalmic (eyes)
Parentral (injection)
Intravenous (into veins)
intramuscular (into muscles)
intradermal (within layers of skin)
subcutaneous (under the skin)
Drug molecules move around the body either through bulk flow (bloodstream, lymphatics or cerebrospinal fluid) or diffusion (molecule by molecule over short distances)
Absorption
Passage of drug from its site of administration into plasma - important for all routes except intravenous injection.
Injection
IV = fastest route of administration
bolus injection = very high concentration of drug
rate limiting factors = diffusion through tissues and removal by local blood flow
Drugs need to pass through membranes (cell membranes, epithelial barriers, vascular endothelium, blood-brain barrier, placenta barrier etc) via
passive diffusion through lipids
carrier-mediated
passage through membrane pores/ion channels
pinocytosis (ingestion into a cell by the budding of small vesicles from the cell membrane)
Diffusion through lipid
non-polar molecules can dissolve freely in membrane lipids
the rate is determined by the permeability coefficient (P)(solubility in the membrane and diffusibility) and the concentration difference across the membrane
pH and Ionisation
Many drugs are weak acids or weak bases
exist in unionised or ionised forms
pH = balance between the two forms
ionised forms have low lipid solubility
uncharged however the drug is usually lipid soluble
ionisation affects:
rate of drug permeation through membranes
steady state distribution of drug molecules between aqueous compartments if pH difference exists between them
Therefore:
urinary acidification accelerates the excretion of weak bases and slows that of weak acids
alkalisation has opposite effect
increasing plasma pH causes weak acids to be extracted from CNS into plasma
Reducing plasma pH causes weakly acidic drugs to become concentrated in CNS, increasing neurotoxicity
Bioavailibility
Bioavailibility (F) indicates the fraction of an orally administered dose that reaches systemic circulation intact, taking into account both absorption and local metabolic degradation
determined by comparison between oral and IV absorption
affected by:
drug preparation
variation in enzyme activity of gut
gastric pH
intestinal motility
Volume of Distribution
Vd is defined as the volume of fluid required to contain the total amount, Q, of drug in the body at the same concentration as that present in the plasma, Cp
determined by relative strength of binding between drug and tissue compared with drug and plasma proteins
tight binding to tissue but not plasma –> drug appears to be dissolved in large volume –> large Vd (eg chloropromazine)
tight binding to plasma –> V can be very close to blood volume –> low Vd (eg warfarin)
Grapefruit Juice & Drug Metabolism
Bergamottin is a natural furanocoumarin found principally in grapefruit juice. It is also found in the oil of bergamot, from which it was first isolated and from which its name is derived.
To a lesser extent, bergamottin is also present in the essential oils of other citrus fruits. Along with the chemically related compound 6’,7’-dihydroxybergamottin, it is believed to be responsible for the grapefruit juice effect in which the consumption of the juice affects the metabolism of a variety of pharmaceutical drugs.
In Which Dr. Baffled Tortures His Residents
I was rounding in the nursery with 2 interns today. There are 7 babies in the nursery. One of them had a large, hyper-pigmented nevus on his right calf. All of the other babies have completely normal exams. When I asked them if any of the babies had any findings on exam they said no. I told them that one baby had a clear abnormality on the exam and they should go back in and re-examine all the babies and find it. They examined babies and reported non-existent findings for an hour with no progress. I then told them which baby had the findings and they then stared at that baby for 20 minutes before they found it. The whole incident was painful to watch.
Whats the moral or the story? A physician’s history and physical exam skills are among the most important aspects of medicine. Without them, you’re just wandering around the diaspora throwing spaghetti at the wall and hoping something sticks.
The hardest battle you will ever have to fight is between who you are now and who you want to be.
Anonymous (via wnq-anonymous)
Effort won’t betray you
my korean friend when I asked her how she motivates herself for lessons that last until 11 pm each day -studybdy (via misehry)
We should be more pro-active or we’ll see more of such sad fates of honest people.
WHAT’S IN MY POCKETS?
Life as an emergency medicine intern can be pretty hectic, but having the right tools in your armamentarium can make things that much easier.
Here are some of the things I carry around on a day to day basis in the emergency department plus a few extras:
Stethoscope
Personally I carry the Littmann Cardiology III Stethoscope. It has served me well for about 4 years now. I think it has one of the best acoustic qualities for those not going into Cardiology. Plus it comes in black!
Stethoscope Hip Clip
White coats get dirty in he emergency department, I stick to just my scrubs mostly. I give my neck a break from hanging my stethoscope around it and clip it to my scrubs pants. Your future orthopedic surgeon thanks you.
Tarascon Adult Emergency Medicine Pocketbook
This book has saved my butt multiple times, especially as a 4th year medical student on Sub-Internship rotations. Faster than opening up your phone and waiting for your WikiEM app to update. Just flip to the back,f ind what your are looking for and BAM! It is especially useful on international rotations when you don’t have internet or data service to spare.
LED Penlight
I think pens with LED lights are less harsh on the patients’ eyes. These pens are still very bright so don’t directly shine them into the patients’ eyes just near them, unless you’re a jerk doctor.
Sanford Guide to Antimicrobial Therapy
A great deal of emergency department patients are discharged or admitted on antibiotic therapy. This helps you decide which drug for which bug without having to guess or remember back to your microbiology block. What if it is male with a UTI not a female? Or a kid with pneumonia? What common bugs need what drugs? This book helps a lot. Warning: paper cuts.
Trauma Scissors
Most trauma patients need their clothes removed. Those who are bleeding out and time is on the essence, whip out these babies and cut through almost anything. Be careful before they cut your dreams.
MEDICAL BOOKS
If you’re looking for some medical (non-textbook) books to read in your limited amount of spare time, check out some of my favorites below:
The House of God by Samuel Shem
A classic pre-medical school book. It details residency life in the 1970s. You can talk about this book with almost any medical student or attending. It is practically a medical school requirement.
Intern: A Doctor’s Initiation by Sandeep Jauhar
A more modern look into medicine residency intern year from the perspective of Cardiologist Dr. Sandeep Jauhar. Comes with the highs and lows you can expect. After having been through 6 months of residency, I would say it is very accurate.
Gifted Hands: The Ben Carson Story by Ben Carson. Just because I find Ben Carson incompetent as a politician does not mean I do not respect him as a doctor. He is a phenomenal pediatric neurosurgeon and this book details his story.
On Doctoring: Stories, Poems, Essays by Richard Reynolds
A book of stories and poems from doctors throughout time and also from famous poets and authors depicting their views of medicine.
Private Practice: In the Early Twentieth-Century Medical Office of Dr. Richard Cabot by Christopher Crenner
An interesting look into a Boston medicine clinic from the early 1900′s. With excerpts from old patient notes which I found very interesting.
And if you have an interest is something more dark:
Blind Eye by James B. Stewart
The real story of a doctor murderer from the 1990′s who killed multiple patients without getting caught for several years.
Devil in the White City by Erik Larson
The story of the World’s Fair in Chicago in the late 1800′s. A great look into the history of Chicago and the murderous doctor who roamed its streets.
And lastly:
The Hitchhiker’s Guide to the Galaxy by Douglas Adams. Just a great book in general. My favorite.
Suggested by other users:
The Making of a Woman Surgeon by Dr. Elizabeth Morgan
Suggested by http://thetay-in-the-757.tumblr.com
This book is my all time favorite, as I am a female aspiring to work in the healthcare system myself. Dr. Morgan chronicles her own journey in the male-dominated arena of medicine in the 1970s and 1980s, as she struggles to maintain an appropriate balance between remaining empathetic towards her patients and yet must toe the line of not becoming too emotionally involved with her patients so that she burns out, as well as maintaining her own femininity in a man’s world.
When Breath Become Air by Dr. Paul Kalanithi
Suggested by http://nandemokandemo.tumblr.com
When Breath Becomes Air is an autobiography written by an esteemed neurosurgeon who discovers he has Stage IV lung cancer in his final stages of residency. It appeals to not only medical students, with his profound impressions of cadaver dissection and his first life and deaths, but also to current medical professionals by questioning philosophical domains of mortality and what a meaningful life is, as well as to non-medical professionals with moving thoughts on family, life, death and meaning. It is not a novel to be missed by any person.
ICU Materials part 1
After 4 years of volunteering in the ICU of the local hospital for respiratory diseases I’ve finally started to really understand a lot of the diagnostic procedures and the meaning of their results.
So I’ve decided to share with you some of the materials I use to study the ICU Stuff:
ABG interpretation
https://abg.ninja/abg - The site gives you a results from ABG analysis and you have to make a reading of them, then it show you if you are correct or wrong and gives you a full description why. On this site there some other very nice medical quzzes as well - Glasgow coma scale, Cranial Nerves, Basic ECG etc.
Lung function tests
http://www.ums.ac.uk/umj080/080(2)084.pdf
http://www.ics.gencat.cat/3clics/guies/184/img/–americanfamilyphysician.pdf In these PDFs the basic aproach to spirometry is described, everything you need to know when you stumble across spirometry results.
Coagulation tests
http://thrombosiscanada.ca/wp-content/uploads/2013/08/Bloody_Easy_Coag_2013.pdf
http://www.pathology.vcu.edu/clinical/coag/Lab%20Hemostasis.pdf Very consise and well writen guidelines for coagulation tests interpretations.
Chest radiology
https://lane.stanford.edu/portals/cvicu/HCP_Respiratory-Pulmoanry_Tab_2/Chest_X-rays.pdf
http://www.southsudanmedicaljournal.com/assets/files/Journals/vol_1_iss_2_may_08/how%20to%20read%20a%20cxr.pdf Basic guidelines for reading a Chest X-ray
Echography - Ultrasound Imaging
http://www.sah.org.au/assets/files/PDFs/For%20Doctors/2011-crit-care-us-heart.pdf
http://www.cardioegypt.com/cardioeg/ACSCA2014-Presentations/002001.pdf
http://www.annalsofintensivecare.com/content/pdf/2110-5820-4-1.pdf
http://www.cardiovascularultrasound.com/content/pdf/1476-7120-12-25.pdf
http://www.ccforum.com/content/pdf/cc5668.pdf Very simple and easy to understand presentations for the newbies(like me) in Ultrasound imaging. To be continued…
Some of my favourite printables! Firstly,apologies for the awful photos,it’s a rainy day and by the time I got home it was getting dark but I just had to post them.
Daily Agenda from @euphoricstudying I really,really like this printable. It’s clean and big,no messing about. However,I liked the grid background on the original which didn’t show up very well on my printed version? This may have just been an issue with the printer(although the grid showed up on another printable so maybe not). All in all this is such a useful printable! I’m likely to use it at the weekends/for particularly busy days and it does everything I need,and well!
To-Do List and Homework Planner from @meddiestudies This is such a cute little to do list!!!! It has just enough spaces so as not to be too overwhelming,I like to use it alongside the daily agenda for specific homework tasks as opposed to general appointments and reminders/scheduling. A really lovely little page!!
Weekly Planner from @arystudies I love love love this planner. It’s everything I could hope for in a weekly planner;simple,grid background, black and white so I can add my own colour schemes weekly! I love the fact Saturday and Sunday have smaller boxes since my weekdays are busier than my weekends what with school. I would definitely recommend trying this planner out,it even has a lovely little water tracker!
Yearly Planner from @emmastudies This is a lovely calendar,I went for the purple colour but there are a few to choose from to match everyone’s tastes. It’s a lovely and simple lay out with plenty of space in each box and some really lovely lettering for the months!
Bookmark Printables (via Google Drive)
Would you guys be interested in free bookmark printables?
I’ve never done these before so feedback would be appreciated (good or bad!). If you guys like these then I could maybe make a better (more pretty) series or even custom ones.
More free printables here.
How I Use Asana to Organize My Life as a Student
Organization.
Ew.
I feel like the words organization, productivity and time management can seem like taboo words to a student. Hearing those words always makes me squirm.
It’s really difficult to get organized and to stay organized. I have tried many different apps, systems and planners to try and get myself organized, but every time I try a new system, it never works out.
When I found Asana, I was so happy that I had finally found a method that clicked. This app helps me organize my tasks for each subject, with helpful tools to that allow me to plan out my weeks and month effectively.
And as someone who values the aesthetic and appearance of an app more than anything, I’m pleased to report that the minimalist and colorful design of this program makes the designer inside me very, very happy.
But you may not have ever heard of Asana before. Which is totally cool. Because in this post, we’ll be covering
how to set up your very own Asana account and profile,
how to manage your tasks and assignments inside the app, and
how to effectively use all of Asana’s amazing tools to further your productivity.
Read the entire post here!
Molecule of the Day: Diazepam/Valium
Diazepam (C16H13ClN2O), also known as Valium, is a white solid that is of significant pharmaceutical importance. It is a member of the benzodiazepine family, which shares the similar bicyclic system comprising of a conjoined benzene and diazepine ring.
Diazepam is used to treat anxiety and panic disorders, and this is achieved by its binding to GABA receptors on neurons. This causes the active site of the receptors to become a better fit for GABA molecules, resulting in a higher binding of GABA to it. This triggers a greater influx of chloride ions into the neuron.
Since the intracellular portion of the neuron is more negative than normal, the membrane is hyperpolarised to a greater extent. Consequently, a stronger stimulus is needed to trigger an action potential, which is created when a stimulus causes the membrane to reach the threshold potential.
Since the resting potential is now more negative, the action potential and thus firing of the neuron is less likely. This then produces the anxiolytic, sedative, amnesia-inducing, and anticonvulsant effects of diazepam.
Diazepam can be produced by various synthetic pathways; one such one is shown below.
Requested by anonymous
ICU Materials part 1
After 4 years of volunteering in the ICU of the local hospital for respiratory diseases I’ve finally started to really understand a lot of the diagnostic procedures and the meaning of their results.
So I’ve decided to share with you some of the materials I use to study the ICU Stuff:
ABG interpretation
https://abg.ninja/abg - The site gives you a results from ABG analysis and you have to make a reading of them, then it show you if you are correct or wrong and gives you a full description why. On this site there some other very nice medical quzzes as well - Glasgow coma scale, Cranial Nerves, Basic ECG etc.
Lung function tests
http://www.ums.ac.uk/umj080/080(2)084.pdf
http://www.ics.gencat.cat/3clics/guies/184/img/–americanfamilyphysician.pdf In these PDFs the basic aproach to spirometry is described, everything you need to know when you stumble across spirometry results.
Coagulation tests
http://thrombosiscanada.ca/wp-content/uploads/2013/08/Bloody_Easy_Coag_2013.pdf
http://www.pathology.vcu.edu/clinical/coag/Lab%20Hemostasis.pdf Very consise and well writen guidelines for coagulation tests interpretations.
Chest radiology
https://lane.stanford.edu/portals/cvicu/HCP_Respiratory-Pulmoanry_Tab_2/Chest_X-rays.pdf
http://www.southsudanmedicaljournal.com/assets/files/Journals/vol_1_iss_2_may_08/how%20to%20read%20a%20cxr.pdf Basic guidelines for reading a Chest X-ray
Echography - Ultrasound Imaging
http://www.sah.org.au/assets/files/PDFs/For%20Doctors/2011-crit-care-us-heart.pdf
http://www.cardioegypt.com/cardioeg/ACSCA2014-Presentations/002001.pdf
http://www.annalsofintensivecare.com/content/pdf/2110-5820-4-1.pdf
http://www.cardiovascularultrasound.com/content/pdf/1476-7120-12-25.pdf
http://www.ccforum.com/content/pdf/cc5668.pdf Very simple and easy to understand presentations for the newbies(like me) in Ultrasound imaging. To be continued…
