imaseriesofunfortunateevents

[imaseriesofunfortunateevents]

Is there a spin-off of tumblr that exists? I am sick of the changes and the censorship. I want the community I once had.

[imaseriesofunfortunateevents]

[imaseriesofunfortunateevents]

[imaseriesofunfortunateevents]

I feel like I'm falling back to my old bad habits and I can't do anything against it.

[imaseriesofunfortunateevents]

Hot Take: Self Victim Blaming

I know this is a hot take, so don't come at me with the hate.

When it comes to myself, I am the biggest victim blamer. Other people? Oh they probably were caught in the wrong place in the wrong time with the wrong person and any form of no means no. Me? What was I wearing, was I flirting, was I having a good time, was I doing anything that could lead one to believe my previous no is now negated? I hate it but I almost feel like by displacing the blame onto the other person I am proving my guilt by deflecting. And then I feel like maybe I am seeking the attention because I could always have done more to make my position clear.

TLDR; I am filled with rage and guilt towards myself despite being told that I did not make it unclear what my position was.

[imaseriesofunfortunateevents]

ECG: quick and dirty

I’ve had countless sessions and lectures on ECGs. I don’t know how many websites I have bookmarked, or how many times my eyes glazed over reading Dubin. I’m also terrible at cardiology. I was on my way to accepting my fate of being horrible at ECGs forever, until I had a life changing session on ECGs taught by a great ER doc. I want to post it here because it was probably the most useful thing I learned in med school, and it will stick with me for the rest of my career. 

WHEN LOOKING AT ECGs FOR THE FIRST TIME:

1. One ECG is never enough. Always get old ones for comparison. If none available, do another one. Because. One ECG is never enough. 

2. RATE. Look at the number on top of the printed ECG. It’s stupid not to use that number. Yes, you should know the rule, 300-150-100-75-60-50. People say you shouldn’t trust the machine because… well, it’s a machine, and it can make mistakes. This is true. I don’t like to look at their “diagnosis” until I have gone through it myself. But the rate is just a number. Plus you should be able to eyeball it and be able to tell if it’s tachy, brady, etc. If the machine is telling you it’s 200 and if it looks tachy, then it’s probably the right number. 

3. RHYTHM. Is there a p-wave for every QRS and a QRS for every p-wave? Is the p-wave upright in lead II and down in aVR? Good. Done. BOOM. It’s sinus rhythm. ***if you cannot clearly see the p-waves then you cannot call sinus. move on.

4. AXIS. Again, look at the number at the top of the page. If it’s between 0 and +90, then it’s normal axis. If the number isn’t provided, or if your preceptor doesn’t believe in the convenience of machines/technology, look at the QRS complex of lead I and lead II. 

up in lead I, up in lead II: normal axis

up in lead I, down in lead II: left axis deviation (most common causes are left anterior hemi block and left ventricular hypertrophy)

down in lead I, up in lead II: right axis deviation (most common causes are right ventricular hypertrophy…PE)

5. did someone say HYPERTROPHY?

look at V1

is the R wave tall? (greater than 7mm?) right ventricular hypertrophy.

is the S wave tall? (greater than 11mm?) left ventricular hypertrophy.

  6. P-waves

look at lead II

is it wide? left atrial enlargement.

is it tall? right atrial enlargement.

7. PR interval

should be between 0.12 sec and 0.2 sec (3-5 small boxes). I used to always get this interval and QRS complex (less than 0.12 sec) mixed up. Think: atria depolarizing + shit getting to ventricles is gonna take longer than ventricles depolarizing. [2 things happening] versus [1 thing happening]. [0.12 sec-0.2 sec] versus [<0.12 sec].

long PR interval means there’s some sort of block at the AV node. 

1st deg block. PR interval is long. everything else is normal. cool. 

2nd deg block

type I: PR interval progressively gets long. eventually a dropped QRS.

type II: PR interval is constant, but randomly dropped QRS. 

3rd deg block “complete block”

there is no association between P waves and QRS. they run separately. **QRS does NOT have to be wide. Just look for P wave/QRS complex disassociation. I sometimes get this and 2nd deg type II mixed up. The only difference I try to remember is that PR interval is constant in 2nd deg type II, but is variable in 3rd deg. 

8. QRS complex

narrow or wide? 

narrow: good. signal coming from somewhere above ventricles. 

wide: think BBB (bundle branch block)

LOOK AT V1 ONLY.

if the last deflection of QRS is DOWN, then it’s a left BBB

if the last deflection of QRS is UP, then it’s a right BBB. super easy. no more of this bunny ears crap. 

9. ST segment

always look from J point, and compare with the isoelectric line of T-P segment (NOT PR interval). 

elevated/depressed… STEMI… duh. indicates ACUTE ischemic changes. 

look for reciprocal changes of the heart. if ST elevation in lateral leads, could see ST depression in the septal leads. PAILS:

posterior up, anterior down

anterior up, inferior down

inferior up, lateral down

lateral up, septal down.  

LBBB can look like STEMI. How to tell?

disconcordant changes is normal. (QRS and STEMI on opposite sides of the isoelectric line.)

concordant changes is abnormal. 

massive discordance is abnormal. (STEMI is greater than 5mm)

this isn’t that important. Moving on. 

Inferior STEMI. Could right ventricle be involved? 

DO NOT GIVE NITRO DO NOT GIVE NITRO DO NOT GIVE NITRO.

order a 15 lead

is STE in lead III > lead II? likely RV involvement

INFERIOR MI? 15 LEAD NO NITRO

INFERIOR MI? 15 LEAD NO NITRO

INFERIOR MI? 15 LEAD NO NITRO

10. T waves

is it inverted? indicates recent ischemic changes. 

11. Q waves

is it significant? indicates old ischemic changes. will likely be present if followed rule number 1 of reading ECGs. (1 ECG is never enough= look at old ECGs). 

I literally go through this list of 11 points in my head when I’m reading an ECG, regardless of whether or not I have an atrial flutter jumping at my face or if I see a massive anterolateral STEMI. Obviously I needed background knowledge on ECGs and the physiology of the heart before constructing this list, but this basic checklist has been very, very useful to me so far. It might look lengthy, but it doesn’t take a lot of time at all- a patient is not likely going to have all these issues with their heart. 

  Anyway. I still don’t love ECGs, but it feels pretty wonderful to be able to be able to evaluate it in a systematic manner, and get the theory behind interpreting the scribbles of an ECG reading. I don’t get these moments as much as I would like to, but it’s that crosspoint where my classroom learning actually meets real-life applications that gives me happy brain-gasms for days. I love knowing things and more importantly, knowing why.

[imaseriesofunfortunateevents]

A just bought a pencil sharpener. Its been 6 years since I really did some damage, and 4 since I last used the blade. Brining temptation in my home is a bad choice and I know it, but I just can't help myself anymore.

[imaseriesofunfortunateevents]

You've got to love the irony of doing self-enhancing and self-destructive behaviors all at once.

On the one hand, I am going to meetings to grow and get past previous trauma so it doesn't weigh me down. On the other hand, I actively put myself in risky positions that will allow that trauma to perpetuate.

It all comes back down to the same question. Do I want to get better and get past it? Or do I like the attention I get from both sides? If you continue to make a mess while picking up the past, you are left with a never-ending series of problems to be fixed.

[imaseriesofunfortunateevents]

[imaseriesofunfortunateevents]

Looking back through old content is just like WOW was I really like that? Did these words and thoughts really come from me? And deep down, I know they did, but damn I hate to see it

[imaseriesofunfortunateevents]

[imaseriesofunfortunateevents]

[imaseriesofunfortunateevents]

Fake Feelings

Is anything I feel real?

Sadness and loneliness. We have a complicated relationship. Am I ever really sad? Am I ever really empty? Or do I just want attention and validation from those around me? But why deceive? Being sad is not cool, it is not hip, but without it I feel my personality start to slip. I want to be happy, and somewhere, I am. But I cannot help but feel that I am lying to the world, just to get a love that is unique to those who are vulnerable and afraid.

Am I truly sad and broken but too proud to admit it? Or am I strong and capable, just unwilling to let go of the past? Is anything I feel real?

[imaseriesofunfortunateevents]

A Flight to Freedom

The last time I rode on a motorcycle I felt so free. I was flying and felt invincible against the world. I was holding on to the driver and just enjoying the ride.

Then I thought about talking off my helmet. I thought about letting my grip loosen. I thought about letting go on the freeway when we were going 70. I thought about truly flying. Flying off the motorcycle. Flying into the median. Flying into my next life. Then, I fly high on the rush of happiness the thoughts give me.

[imaseriesofunfortunateevents]

[imaseriesofunfortunateevents]

I got 1 task done today. I emptied the big trash can in my bedroom. That's one less fork to deal with.

I have severe executive dysfunction. I've been dealing with it by having myself do one small task a day. So far it's helped a lot. By doing it this way my brain doesn't freak out trying to tackle everything at once.

I got my inspiration for it from this Donald Duck comic: