1. ”Dow Jones Industrial Average Closing Stock Report” stands for?
Answer: Components of the intestine

It stands for the major parts of the intestine: duodenum, jejunum, ileum, appendix, colon, sigmoid, rectum

2. What does this stand for: LAB RAT?

Answer: Heart valves

To be more exact, the mnemonic stands for the valves between the atria and the ventricles: left atrium: bicuspid; right atrium: tricuspid. There are also the pulmonary and aortic valves.

   .

3. What do these numbers stand for? 1,3,5,7,9,11.Answer: Numbers related to the spleen

The spleen is 1 inch thick, 3 inches high and 5 inches wide. It weighs 7 oz and lies below ribs 9-11.

  

4. Don’t Exercise In Quicksand. Good advice, and a mnemonic for which part of human anatomy?
Answer: Respiratory muscles

It stands for diaphraghm, external intercostals, internal intercostals, quadratus. The diaphraghm is the main respiratory muscle. The intercostals are between the ribs. The quadratus lumborum anchors the diaphraghm.

   

5. Mailing Includes Stamps - what does this mnemonic stand for?
Answer: Bones within the ear

From the outside to the inside they are the malleus (hammer), incus (anvil), stapes (stirrups).

6. What does this stand for: AC/DC Rocker Kids Party Down?
Your Answer: Major retroperitoneal organs

In no particular order they are the ascending colon, descending colon, rectum, kidneys, pancreas and duodenum.

7. ”Happy Tom Cat Took Pie To Little Sister” stands for?
Answer: Carpal bones

They all refer to bones of the wrist: hamate, trapezoid, capitate, trapezium, pisiform, triquital, lunate, scaphoid.

   

8. What does this stand for: PEST OF 6?Answer:Cranial bones

They are the parietal, ethmoid, sphenoid, temporal, occipital and frontal bones. The 6 is supposed to remind students that there are six bones.

9. PULSE stands for?
Answer: Symptoms of a heart attack

If you experience “persistent chest pain, upset stomach, lightheadedness, shortness of breath and excessive sweating” get to your nearest ER or call EMS.

 

10. What does APGAR stand for?
Answer: Assessment of the newborn

The letters stand for activity, pulse, grimace, appearance, respiration. A healthy newborn should be moving about, crying, have good skin colour and a heart rate above 100 bpm.

11. What condition does BOYLE stand for?
Answer: Decompression sickness

Breathe Or Your Lung Explodes; it is a reminder of Boyle’s law: volume of gas is inversely proportionate to its pressure. Robert Boyle was a scientist in the 17th century.

12. ABCDE stands for?
Answer: Resuscitation steps

The letters stand for “airway, breathing, circulation, drugs, environment”, an extension of the older “ABC”.

13. What would you treat with RICE?
Answer: Sports injuries

Rest, ice, compression and elevation work well for sprains, bruises etc.

  

14. What does this stand for: SOAP?
Answer:Examination organization

This is a specific way of charting: subjective (what the patient says); objective (what the examiner sees); assessment (diagnosis); plan (treatment).

15. Oh Once One Takes The Anatomy Final A Good Vacation Seems Heavenly. This heartfelt sentiment stands for which anatomical structures?

Cranial nerves

There are twelve cranial nerves: olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, auditory, glossopharyngeal, vagus, spinal root of the accessory and hypoglossal.

                                        

(Speech delivered by Chief Justice Renato C. Corona during the blessing of the Justicia Room, Ateneo Law School, Ateneo Professional Schools Building, Rockwell Center, Makati City,     7:00 p.m., February 10, 2012)

Transfusion Reaction - MNEMONICS

• DEFINITION :
  • Transfusion Reaction :
    • Any Adverse Reaction / Events Experienced By A Patient In Association With A Transfusion - Regarded As A Suspected Transfusion Reaction, Until Proven Otherwise. (FRIDEY, 2003).
• OVERVIEW :
  
  • Transfusion Reaction :
    
    • Acute Immune Mediated, Delayed Immune Mediated, Non Immune Mediated
  • Acute Immune Mediated :
    • Acute Hemolytic Transfusion Reaction, Allergic Reaction,Febrile Non-Hemolytic Transfusion Reaction, Transfusion Related Acute Lung Injury (TRALI)
  • Delayed Immune Mediated :
    • Delayed Hemolytic Transfusion Reaction, Transfusion Associated Graft Versus Host Disease, Post Transfusion Purpura (PTP)
  • Non Immune Mediated :
    • Non Immune Hemolysis, Transfusion Associated Sepsis, Transfusion Associated Overload

• EPIDEMIOLOGY :
  • Frequency Of Immunology Reaction Per Unit Of Blood :
    • Allergic Reaction - 1 : 100
    • Febrile Non-Hemolytic Transfusion Reaction - 1 : 100
    • Delayed Hemolytic Transfusion Reaction - 1 : 600
    • Acute Hemolytic Transfusion Reaction - 1 : 50,000
    • Fatal Hemolytic Reaction - 1 : 500,000
  • Infectious Complications Per Unit Of Blood
    • Hepatitis B - 1 : 81,000
    • HTLV-1 - 1 : 642,000
    • Hepatitis C - 1 : 1,600,000
    • HIV-1 - 1 : 2,000,000
• RISK FACTORS :
  • Multiple Blood Transfusions
  • Rh - Negative Mother
  • Multiple Pregnancies
• CLASSIFICATION :
  • Acute Immune-Mediated :
    • Acute Hemolytic Transfusion Reactions
      • Etiology : 
        
        • ABO Red-Cell Incompatibility
        • Due To Clerical Error Resulting In Mistransfusion.
      • Clinical Manifestation :
        
        • Fever (1 Degree Celcius Or 2 Degree Fahrenheit) And / Or Chills, Which Was Associated With Pain At Infusion Site, Headache, Nausea And Vomiting, Anxiety, Hemoglobinuria, Renal Failure, Hypotension (Anaphylactic Shock), DIC, And Back Pain, Which Typically Evolve During Or Immediately Following Transfusion.
        • Severity Of The Reaction Is Proportional To The Amount Of Incompatible Blood Transfused
    • Allergic Reaction
      • Etiology :
        • Hypersensitivity Reactions To Allergens In The Transfused Component
      • Clinical Manifestation :
        • Pruritus, Flushing, Dyspnea, Urticaria (Common), Or With Angioedema (Less Common), Which Occur Within Minutes Of The Initiation Of Transfusion
    • Febrile Non-Hemolytic Transfusion Reaction
      • Etiology :
        • Probably Immune Mediated, 
        • Although The Mechanism Appears To Be Multifactorial
      • Clinical Manifestation :
        • Fever, (1 Degree Celcius Or 2 Degree Fahrenheit) And / Or Chills, Which Was Associated With Headache, Malaise For Which No Other Cause Is Identifiable With NO HEMOLYTIC MANIFESTATION
        • Most Episodes Are Benign, But Initially May Be Indistinguishable From The Onset Of An Acute Hemolytic Transfusion Reaction (WITH HEMOLYTIC MANIFESTATION)
    • Transfusion-Related Acute Lung Injury (TRALI)
      • Etiology :
        • Rare Type Of Neutrophilic Reaction
        • Occur As A Result Of Granulocyte Activation In The Pulmonary Vasculature, Resulting In Increased Vascular Permeability And PULMONARY EDEMA
      • Clinical Manifestation :
        • Marked Respiratory Distress (Sudden Onset Of Dyspnea And Tachypnea), Often Accompanied By Fever (1 Degree Celcius Or 2 Degree Fahrenheit), Tachycardia, Hypotension, Hypoxia, And Bilateral Pulmonary Edema 
        • Onset : 
          
          • COMMON : Within 1 - 2 Hours Of Transfusion
          • OCCASIONALLY : Can Be Seen As Early As During Transfusion To As Long As 6 Hours.
  • Delayed Immune-Mediated :
    • Delayed Hemolytic Transfusion Reactions
      • Etiology :
        
        • Most Often Are Caused By Antibodies To The Rh System, But Others (Such As : Kell, Duffy, Kidd) Are Also Common.
      • Clinical Manifestation :
        • Generally Non-Preventable
        • Present With Fever Or Anemia Occuring Days To Weeks Following Transfusion
        • Others : Jaundice, Hemoglobinuria (Due To Extravascular Hemolysis), Acute Renal Failure, DIC.
        • Diagnosis :
          • Newly Identified Positive Direct Antiglobulin Test And / Or Positive Antibody Screening During The Preparation Of A Subsequent Transfusion.
    • Transfusion Associated Graft-Versus-Host Disease
      • Etiology :
        • Rare Complication Which Usually Seen In Immunodeficient Patients, Resulting From Transfusion Of Viable, Donor Lymphocytes.
        • The Donor’s Lymphocytes Have Common Antigens And Are Not Recognized As Foreign Body By The Recipient. However, These Lymphocytes See The Recipient As Foreign Body, Leading To Fulminant Multiorgan System Failure And Death.
      • Clinical Manifestation :
        • Maculopapular Rash, Fever, And DIarrhea
        • Onset : 8 To 10 Days Following Transfusion
        • Tends To Lead To marrow Aplasia
        • Progress Rapidly Towards Death.
    • Post-Transfusion Purpura (Thrombocytopenia - PTP)
      
      • Etiology :
        
        • Occurs As A Result Of Prior Sensitisation To Foreign Platelet Antigen, Usually During Pregnancy.
      • Clinical Manifestation :
        • Disseminated Purpura
        • Bleeding From Mucous Membranes, GI Tract, And Urinary Tract  (Due To Thrombocytopenia)
  • Non Immune-Mediated
    • Non-Immune Hemolysis
    • Transfusion-Associated Sepsis
      • Etiology :
        • Viruses, Bacteria, Or Protozoans
        • Risk Of Infection Is LOW, But Still Present
      • Clinical Manifestation :
        • Fever, Sepsis, Hypotension
      • Prevention :
        • SCREENING - Donor Screening By Performing Standard Laboratory Assays
        • STERILIZATION - For Some Plasma Components
        • ASEPTIC TECHNIQUE - Sterile Technique During Blood Transfusion Administration.
    • Transfusion-Associated Circulatory Overload (TACO)
      
      • Etiology :
        • Volume Or Iron Overload
        • Volume Overload - Common Seen In Older Patients And In Patients With Cardiac Disease.
        • Iron Overload - Common Seen In Patients Requiring Chronic Transfusions.
      • Clinical Manifestaion :
        • Pulmonary Edema
      • Prevention :
        
        • Volume Overload :
          • Decrease Infusion Rate Or 
          • Diuretic Administration.
        • Iron Overload :
          • Chelation Therapy
    • Others :
      • Hypothermia - If  Blood Product Is Not Sufficiently Warmed Before Transfusion 
      • Hyperkalemia - If Blood Products Contain An Older Or Damaged RBCs
        • Increase Risk Of Cardiac Arrhythmias. 
      • Hypocalcemia - If Blood Product Contain A Lot Of CITRATE (Blood Preservative That Prevent Clotting)
        • Increase Risk Of Muscle Tremors And Cardiac Arrhythmias.
• Laboratory Work-Up :
  • Acute Hemolytic Transfusion Reaction :
    • Positive Direct Antiglobulin Test (COOMBS TEST)
    • Free Hemoglobin - Red Or Pink Plasma Obtained 2 - 4 Hours After Lysis
    • Elevated Serum Bilirubin (MILD)
    • Elevated Lactate Dehydrogenase (LDH)
    • Reduced Serum Haptoglobin
    • Hemoglobinuria - Wine Colored Urine
    • Blood Bank Incompatibility Evaluation
    • Monitor BUN, Creatinine - Increased Risk Of Acute Renal Failure
• Management :
  • IMMEDIATE RECOGNITION - ESSENTIAL
  • STOP The BLOOD TRANSFUSION
  • KEEP THE INTRAVENOUS LINE OPEN With 0.9% SODIUM CHLORIDE
  • SUPPORTIVE :
    • Airway Management (Ventilation Support) And Oxygen
    • Fluid Resuscitation
  • ANAPHYLAXIS REACTION :
    • Epinephrine (Adrenaline) - Primary Treatment If With No Absolute Contraindication
  •  
    • Doses :
      • 300 µg OR 0.3 mL Adrenaline Injection 1 In 1000 - IM ROUTE 
      • Recommended Dose :
        • 500 µg OR 0.5 mL Adrenalin Injection 1 In 1,000 - IM ROUTE
      • Dose May Be Repeated If Necessary At 5 Minute Intervals According To Blood Pressure, Pulse, And Respiratory Function
      • Can Also Be Given INTRAVENOUSLY - With SPECIAL PRECAUTIONS
    • 
      
    • ANTIHISTAMINES And STEROIDS
      • SECOND LINE Treatment For An Anaphylaxis Reaction
      • Antihistamine
        • Help To Counter The Histamine-Mediated Vasodilatation And Bronchoconstriction
        • UNLIKELY To Be LIFE-SAVING In A TRUE ANAPHYLAXIS REACTION If USED ALONE.
        • Dose : Chlorpheniramine 10 mg IM Or IV Slowly (Adults)
      • Steroids
        • Help To Prevent Or Shorten Protracted Reactions
        • DOSE : 200 MG IM OR IV Slowly (Adults)
          • OTHER DRUGS :
            • Bronchodilators
              • Salbutamol, Ipratropium, Aminophylline, Or Magnesium
            • Cardiac Drugs :
              • Vasopressors And Inotropes - Such As : Noradrenalin, Vasopressin, Metaraminol, And Glucagon
              • Atropine - If With Severe Bradycardia
          • FURTHER INVESTIGATION Of ETIOLOGY
        • MNEMONICS : 
          
          • Common Transfusion Reaction - GOT A BAD UNIT
          • G - GRAFT VERSUS HOST DISEASE
          • O - OVERLOAD (IRON, VOLUME)
          • T - THROMBOCYTOPENIA (POST TRANSFUSION PURPURA)
          • A - ALLOIMMUNIZATION
          • B - BLOOD PRESSURE INSTABILITY (ANAPHYLACTIC SHOCK)
          • A - ACUTE HEMOLYTIC REACTION
          • D - DELAYED HEMOLYTIC REACTION
          • U - URTICARIA (ALLERGIC CUTANEOUS)
          • N - NEUTROPHILIC (FEBRILE)
          • I - INFECTION (HIV, HEPATITIS, CMV, BACTERIAL SEPSIS)
          • T - TRANSFUSION ASSOCIATED LUNG INJURY (TRALI)

A Life-Changing Case for Doctors in Training

Good morning everyone!

I Went to Celine’s place! Happy to see her in her red pajamas…Lucky for Amado and Jojo for having a 10.2lb-gift from God! Welcome dear Celine!

The joy of bringing out a child into this world is limitless and incomparable. It is hard but gives women a sense of achievement. For us moms, this memorable experience comes with greater responsibility.

All well and good, but at an early stage of her life Celine went into a birth delivery complication called MAS (Meconium Aspiration Syndrome). And as we go through this journey, you will know more about this case.

Meconium Aspiration Syndrome

What is a Meconium?

Meconium is the earliest stool of an infant. This is composed of materials ingested during the time the infant spends in the uterus: intestinal epithelial cells, lanugo, mucus, amniotic fluid, bile, and water. It should be completely passed by the end of the first few days of life, with the stools progressing toward yellow (digested milk). The term Meconium derives from meconium-arion, meaning “opium-like”, in reference either to its tarry appearance or to Aristotle’s belief that it induces sleep in the fetus.

Meconium aspiration syndrome (MAS, alternatively “Neonatal aspiration of meconium”) is a medical condition affecting newborn infants. It occurs when meconium is present in their lungs during or before delivery.

PATHOPHYSIOLOGY

The pathophysiology of MAS is due to a combination of primary surfactant deficiency and surfactant inactivation as a result of plasma proteins leaking into the airways from areas of epithelial disruption and injury.

The leading three causes of MAS are

1. Due to physiologic maturational event
2. A response to acute hypoxic events
3. A response to chronic intrauterine hypoxia

If an infant inhales this mixture before, during, or after birth, it may be sucked deep into the lungs. Three main problems occur if this happens:

• the material may block the airways
• efficiency of gas exchange in the lungs is lowered
• the meconium-tainted fluid is irritating, inflaming airways (pneumonitis) and possibly leading to chemical pneumonia.

These can lead to possibly fatal or long term health problems for the infant.

Risk factors  of MAS:

• Decreased oxygen to the infant while in the uterus
• Diabetes in the pregnant mother
• Difficult delivery or long labor
• High blood pressure in the pregnant mother
• Passing the due date

The risk of MAS increases after the 40th week of pregnancy

SYMPTOMS

• The most obvious sign that meconium has been passed during or before labor is the greenish or yellowish appearance of the amniotic fluid. 
• The infant’s skin, umbilical cord, or nailbeds may be stained green if the meconium was passed a considerable amount of time before birth. 
• Rapid or labored breathing
• Cyanosis
• Slow heartbeat, a barrel-shaped chest 
• Low APGAR 
• Abnormal lung sounds (diffuse crackles and rhonchi)
• Limpness in infant at birth

DIAGNOSIS

• Blood Gas shows 

 

1. Low O2 in Mild MAS
2. Low O2 and increase CO2 in Mod MAS
3. Low ph, low O2, increase CO2 in Severe MAS

• Serum electrolytes: Obtain sodium, potassium, and calcium concentrations at 24 hours of life in infants with meconium aspiration syndrome because the  syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and acute renal failure are frequent complications of perinatal stress.
• Chest Xray may show patchy and streaky areas

Meconium aspiration.

Radiograph obtained shortly after birth shows ill-defined, predominantly perihilar opacities in the lungs; these are more severe on the right than on the left. The lungs are hyperexpanded. The neonate’s heart size is within normal limits. The abnormalities on the initial chest radiograph, aside from the presence of an endotracheal tube and an umbilical artery catheter, are identical to those seen in severe cases of transient tachypnea of the newborn.

DIFFERENTIALS

•  Aspiration Syndrome
•  Congenital Diaphragmatic Hernia
•  Pneumonia
•  Pulmonary Hypertension
•  Sepsis
•  Transient tachypnea of newborn

TREATMENT

A tube is placed in the infant’s trachea and suction is applied as the endotracheal tube is withdrawn. This procedure may be repeated until meconium is no longer seen in the suction contents.

The infant may be placed in the special care nursery or newborn intensive care unit for close observation. Other treatments may include:

• Antibiotics to treat infection
• Breathing machine (ventilator) to keep the lungs inflated
• Oxygen to keep blood levels normal
• Radiant warmer to maintain body temperature

If there have been no signs of fetal distress during pregnancy and the baby is an active full-term newborn, experts do not recommend deep suctioning of the windpipe, because it carries a risk of causing a certain type of pneumonia.

PROGNOSIS

Meconium aspiration syndrome is a leading cause of severe illness and death in newborns.

In most cases, the outlook is excellent and there are no long-term health effects.

In more severe cases, breathing problems may occur. They generally go away in 2 - 4 days. However, rapid breathing may continue for days.

An infant with severe aspiration who needs a breathing machine may have a more guarded outcome. Lack of oxygen before birth, or from complications of meconium aspiration, may lead to brain damage. The outcome depends on the degree of brain damage.

Meconium aspiration rarely leads to permanent lung damage.

So here we are at the end of this case. Congratulations to Celine! Her doctor worked hard to pull her through this crisis.

Hmmm and for me… break a leg and hoping to be one soon! :)

Now that AOG reached 37 weeks, you are now anticipating of the day you will go into labor. Mixed of excitement and fear is within you. Excited to see and feel your baby as well as scared of the pains that labor will bring you.

At 37 weeks AOG, you are now having questions and concerns on your labor and delivery. How will you know that you are in labor?

“Labor is caused by series of progressive expulsive contractions by the uterus and results in delivery of the baby from the mother’s womb to the outside world.” 

Labor is a minimal pain in the beginning but becomes more frequent as the labor progresses. The pain that you will feel is due to contractions of the uterus. These contractions squeeze your baby down the birth canal. Contraction pain comes with interval of 15-20 minutes and slowly the frequency goes down to every 1-5 minutes interval.

 

The cervix dilates and its opening enlarges from 2 cms to 10 cms. This dilatation is required to deliver the head wherein you will feel the urge to push. The first stage of labor is usually longer on primigravida lasting from 24 hours to 36 hours. The second stage labor begins when cervix is fully dilated until the delivery of your baby. Some healthcare provider cuts the outer vaginal ring (episiotomy). This stage lasts from 30 minutes to 2 hour for first delivery. After the delivery of the baby, placenta follows. This is the organ that nourishes the baby when inside the womb. It is attached to the umbilical cord, and has to be tied up to detach from the baby.

Mechanism of vaginal birth

The erect posture causes the weight of the abdominal contents to thrust on the pelvic floor, a complex structure which must not only support this weight but allow three channels to pass through it: the urethra, the vagina and the rectum. The relatively large head and shoulders require a specific sequence of maneuvers to occur for the bony head and shoulders to pass through the bony ring of the pelvis. A failure of these maneuvers results in a longer and more painful labor and can even arrest labor entirely. All changes in the soft tissues of the cervix and the birth canal depend on the successful completion of these six phases:

1. Engagement of the fetal head in the transverse position. The baby’s head is facing across the pelvis at one or other of the mother’s hips.
2. Descent and flexion of the fetal head.
3. Internal rotation. The fetal head rotates 90 degrees to the occipito-anterior position so that the baby’s face is towards the mother’s rectum.
4. Delivery by extension. The fetal head passes out of the birth canal. Its head is tilted backwards so that its forehead leads the way through the vagina.
5. Restitution. The fetal head turns through 45 degrees to restore its normal relationship with the shoulders, which are still at an angle.
6. External rotation. The shoulders repeat the corkscrew movements of the head, which can be seen in the final movements of the fetal head.

The fetal head may temporarily change shape substantially (becoming more elongated) as it moves through the birth canal. This change in the shape of the fetal head is called molding and is much more prominent in women having their first vaginal delivery.

For more informations regarding the stages of labor, you can visit this site: 

http://www.pregnancy-info.net/labor_stages.html

Now that I have given you of an overview of what you will go through during your labor and delivery, let me help you prepare and organize pregnancy checklist.

What I did the first time I pack, I prepared 3 bags. My Labor bag, hospital bag, and my baby bag.

Labor Bag: 

• Package of baby’s clothing, mittens, socks, hooded towel and newborn diaper
• Put in your hair essentials, clips or anything that will keep your hair back or a headband will come in handy when labor becomes intense.
• Facial wipes will make you feel fresh 
• Lip balm for chapped lips 

Hospital bag:

• Postpartum dress (anything comfortable for you)
• Homecoming mom’s outfit
• Nursing bra (I encourage breastfeeding for the benefit of you and your baby’s immune system)
• Comfortable footwear
• Maternity Pads (whether you ar vaginal or Cesarean section)
• Another Headband and hairbrush
• Wet tissue
• Toothpaste, toothbrush
• Face towel
• Alcohol
• Feminine Wash (Betadine)
• Shampoo and Soap
• Deodorant
• Cosmetic Bag (optional :))

Baby Bag

• Baby’s homecoming outfit
• mittens
• socks
• diaper
• blankets
• undershirts
• hooded towels
• bottle of gentle baby wash
• thermometer
• Light weight portable bed 
• breastfeeding pillow
• burp cloths
• 2 bottles
• suction
• Bibs

Enjoy your journey to motherhood and God bless you!