Wednesday was very slow. It was my classmate's turn to scrub-in on the sole c-section scheduled that day, so I bided my time in the triage ward. The only potentially interesting patient turned out to have heart burn. Hey, everyday can't be thrilling!
Yesterday, we each had to do a 15 minute evidence based medicine presentation in front of the clerkship director. The presentation had to include a case presentation of a patient that inspired a clinical question and a scientific paper that attempts to answer the question. We then have to bust-out our dusty biostatistics skills to critique the study. As was to be expected, everyone over-prepared for this pass/no pass assignment and spoke for 20-25 minutes. Other than going way over on length, the presentations were all very well done.
Today I got to scrub in to another c-section. This time it was just me, one resident and an attending at the bedside. This attending is known for letting med students actually do things, and he definitely made good on that rumor. Accordingly I did my first stitch on a live person today! I got to close the outermost layer of the incision using three sutures and a dozen or so staples. I'd like to say I was a natural, but that couldn't be further from the truth. I was awkward and slow and bad at just about every step. I picked up the pick-ups (tweezers) wrong every time; I couldn't remember how to tie knots properly; I had a hard time grasping the skin with the pick-ups; I kept clamping my glove in the suture-clamps when trying to protect the needle (secure the pointy part inward, so it can't poke anyone). It was an all-around disaster. Thankfully, everyone was fairly patient with me, so I didn't run crying from the OR or anything.
WednesdayIL: ...how little we know about pain management during pregnancy. As I promised on Tuesday, I wanted to look into the options for pain management, so I chose that as my clinical topic for my evidence-based medicine presentation. What I learned while researching the topic was rather disheartening. We are so afraid of doing research on pregnant women (for good reason) that there is very little data on the dangerousness of many drugs on the pregnant population. Here is some of the little we think we know:
- NSAIDs: Animal models show early fetal formation effects. Thereafter, there is a small increase in structural defect risk. Avoid them at late-term due to effects on labor, postpartum bleeding, neonatal platelet and ductus development.
- Acetaminophen: Possible long term asthma risk for the baby, but generally safe.
- Opioids: May cause congenital heart defects and neural tube defects early on. Respiratory depression is the big risk during labor. Long term exposure can lead to addiction, which can cause many adverse effects.
YesterdayIL: ...about some studies' findings regarding OB/GYN health, thanks to the presentations from my classmates. Here's the one sentence breakdown:
- Early screening and treatment of asymptomatic bacterial vaginosis (overgrowth of bacteria in the vagina) can lead to far fewer fetal and maternal complications, including spontaneous abortions.
- Preterm premature rupture of membranes (PPROM) can either be treated with immediate delivery or expectant management, with neither posing a significantly greater risk to the fetus or mother.
- Something something preeclampsia and high blood pressure... I don't actually remember the study this person discussed, but they did a very good background presentation on preeclampsia and high blood pressure.
- There were similar outcomes in a study that compared immediate medical management of a missed or partial spontaneous abortion with one week of expectant management prior to initiating medical management.
- Though insulin is the gold standard treatment for chronic and gestational diabetics during pregnancy, metformin provides similar levels of efficacy and safety.
Also, wearing the big scrub boots instead of just the slipper-like shoe coverings is a good idea in the L&D OR. Got a giant red blob of something on me today that would have totally fallen on/in my shoe had I not been wearing the extra layer.