The MD Out of Duty

This is a blog about anything and everything this MD is thinking about; from academic medical information to hobbies and activities outside the healthcare field.
Awakening my calligraphy skill… Still strongly considering getting myself a fountain pen or brush pen.

Awakening my calligraphy skill… Still strongly considering getting myself a fountain pen or brush pen.

"C" Hobbies

To prevent burnout from happening to the best of us, we must refrain from the daily grind and get to some place else to do something different. We do this to refresh our minds, to let off steam, to ignite our other passions. 

I haven’t been writing lately, so here are updates in terms of recent whims.

Culinary

My brother and I just signed up for a cooking class, and it’s not just an ordinary lesson in the kitchen. We will be making vegan sausages from scratch! kitchenrevolution.ph’s Marie Gonzalez

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Photo from http://kitchenrevolution.ph

will be teaching us about 4 recipes and we’re so excited because it will be the first time we’d be attending a real cooking class; and a bonus is that it is vegan! I have a feeling I’ll sign up for another one of her classes after this, but for now, I have got to prepare the things to bring (i.e. apron, food containers, etc.). I hope we get to take home enough leftovers for the family and for my dutymates when I get to the hospital.

Calligraphy

I was browsing (AKA “stalking”) someone’s Instagram when I saw how beautiful the letterings of the user were. I’ve seen a lot of calligraphy before, and it didn’t seem big of a deal to me that people were making so much effort to write in an artsy fartsy way. But the aesthetics got to me lately, and it made me want to learn to do that as well. Most people think my handwriting sucks; I do think that as well, but at times, especially when I use gel or sign pens, my penmanship seemed really cool. So I decided to look online for books on calligraphy, and stumbled upon this:

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The book (the sample, at least) showed really colorful ways of getting lettering done, similar to the Instagram posts I saw previously. So, I was thinking of getting myself a fountain pen. To make my art investment worthwhile, I have got to ask my friend P about her calligraphy experiences and knowledge on pens.

May our cooking skill be enhanced with more healthy recipes and may I provoke the ember on my beginning curiosity of lettering!

Life will hit you hard in the face, wait for you to get back up just so it can kick you in the stomach. But getting the wind knocked out of you is the only way to remind your lungs how much they like the taste of air.

— B, Sarah Kay (via quoted-by)

(via quoted-by)

Anaphylaxis or not?

A few days back, I have encountered two cases of hypersensitivity reaction. Here is case number 1:

A 26-year old female, with a known allergy to Salbutamol, minutes after having eaten fried milkfish for breakfast, had a feeling of warmth and appeared red all over. She also started having difficulty breathing, thus prompting her to go to the emergency room.

Upon ER consult, she was tachycardic with a heart rate of around 140s but she was normotensive and normothermic. Respiratory rate was less than 30.

I could not yet remember what the criteria for diagnosing anaphylaxis were, and I had to review it… So, I just looked up the World Allergy Organization guidelines for the assessment of anaphylaxis. The clinical criteria are any one of the following:

  1. Acute onset of an illness (minutes to several hours) with involvement of the skin, mucosal tissue, or both (e.g., generalized urticaria, itching or flushing, swollen lips-tongue-uvula); AND AT LEAST ONE OF THE FOLLOWING
  • Respiratory compromise (e.g. dyspnea, wheeze-bronchospasm, stridor, reduced PEF, hypoxemia)
  • Reduced blood pressure or associated symptoms of end-organ dysfunction (e.g. hypotonia [collapse], syncope, incontinence)
  1. d
  2. Two or more of the following that occur rapidly after exposure to a likely allergen for that patient (minutes to several hours)
  • Involvement of the skin-mucosal tissue (e.g. generalized urticaria, itch-flush, swollen lips-tongue-uvula)
  • Respiratory compromise (e.g. dyspnea, wheeze-bronchospasm, stridor, reduced PEF, hypoxemia)
  • Reduced blood pressure or associated symptoms (e.g. hypotonia [collapse], syncope, incontinence)
  • Persistent gastrointestinal symptoms (e.g. crampy abdominal pain, vomiting), OR
  1. s
  2. s
  3. Reduced blood pressure after exposure to known allergen for that patient (minutes to several hours)
  • Infants and children: low systolic blood pressure (age-specific) or greater than 30% decrease in systolic blood pressure
  • Adults: systolic blood pressure of less than 90 mmHg or greater than 30% decrease from that person’s baseline

Here’s another case:

A 21-year old female came into the emergency room for dyspnea and development of wheals all over her face and chest minutes after touching their neighbor’s pet cat (exposure to dander). She claimed to have been exposed to cats in the past had never had any allergic reaction to them.

Upon arrival, her O2 saturation was 93% and she was immediately given O2 support, injected with 50mg dyphenhydramine and 100mg hydrocortisone.

After reading the guidelines, I now know that these patients truly had anaphylaxis. This is a better and more accurate-sounding diagnosis than hypersensitivity reaction!

Let me try to apply what I have learned with my reading. Earlier this week, our consultant emphasized the importance of choosing the right intravenous fluid for surgical patients; they may have been put on nothing per orem, have electrolyte deficiencies, and it is paramount that we know what effects our choices would make with regards to the patients’ condition.

Now, let us try deciding on preoperative fluid therapy. Let me use myself as an example. According to Schwartz Textbook of Surgery 10th edition, the formula in computing the volume for maintenance fluids is as follows:

For the first 0-10kg, give 100 ml/kg per day

For the next 10-20kg, give an additional 50 ml/kg per day

For weight >20kg, give an additional 20 ml/kg per day

The example given by the textbook using the formulas above is here below:

A 60-kg female would receive a total of 2300 ml of fluid daily:

1000 ml for the first 10 kg of body weight (10 kg x 100 ml/kg per day);

500 ml for the next 20 kg (10 kg x 50 ml/kg per day); and

800 ml for the last 40 kg (40 kg x 20 ml/kg per day)

Now, let’s say I weigh about 47kg:

I would receive a total of 2040 ml of fluid daily:

1000 ml for the first 10 kg of body weight (10 kg x 100 ml/kg per day);

500 ml for the next 10 kg of body weight (10 kg x 50 ml/kg per day); and

540 ml for the last 27 kg of body weight (27 kg x 20 ml/kg per day)

Also, according to the textbook, hypotonic solutions are used such as 5% dextrose in 0.45% sodium chloride at 100 ml/h as initial therapy. So, do I just use one bottle of IVF as initial therapy here or follow my daily fluid requirement of 2040 ml already?