Pulmonary embolism: diagnosis and treatment in the hospital setting

I know this will be very exciting for many of you. For work, I was asked to read an article and give a summary of it. This is a review article on acute pulmonary embolisms and how they are treated and dealt with, mainly in the hospital setting. 

For your pleasure, if you want to go and find the article:

Agnelli, Giancarlo and Cecilia Becattini. (2010). Acute Pulmonary Embolism. The New England Journal of Medicine, 363(3), 266-74.

A pulmonary embolism is a serious problem that should be considered in several classes of patients.  Those with new or worsening difficulty breathing, chest pain or sustained hypotension without an obvious alternative cause should be assumed until proven otherwise.

Each patient should undergo a clinical probability assessment to determine the likelihood of the patient experiencing a PE through either clinical judgment or clinical decision rules (Wells and revised Geneva scores). During the assessment, the patient is determined to be hemodynamically stable or unstable. The stable category is split into two further categories: low/intermediate clinical probability and high clinical probability. Those with the high clinical probability will proceed to the CT scan to confirm or rule out the presence of a pulmonary embolism. The low/intermediate clinical probability group will receive D-dimer testing. The results of that test will determine the next step for the patient. Caution should be used for elderly patients, pregnant women and patients with cancer as the specificity of an increased D-dimer level is reduced in these populations. A normal D-dimer result rules out a pulmonary embolism. If it is elevated, the patient is sent to the CT scanner to determine the presence or absence of a PE.

It's Thanksgiving!

A day of running around to different houses to see lots of people, eat lots of food, get really stuffed...and then roll back home and into bed and sleep the rest of winter.

Today, however, I am not going to talk about my Thanksgiving traditions but rather some of the things I am most thankful for.

I am thankful that I was raised in a Christian home and brought up in a Bible-believing church where I came to know Christ as my Savior. Without Him, I would have no true purpose. He is the reason I have hope, life and can love.

I am thankful for my family. Despite the craziness that surrounds it, they are still family and I do love them.

I am thankful that I live in a free country. (I'm not interested in getting into politics here.) I know that freedom (for us...or anybody) comes at a cost. I am thankful for those who gave up their lives to better mine.

I am thankful for my job. It is a strange, weird, crazy, stressful, sometimes unsafe job...but I love it and I am so thankful for the opportunity I have to impact the lives of others in that tangible way.

I am thankful for my friends. They help keep me grounded and keep my head screwed on straight. They know I'm weird and like me anyway. I know I can count on them for anything -- and I appreciate that.

Last, but absolutely not least (probably my most favorite), I am so thankful for my wonderful boyfriend. I am thankful that he loves me no matter how silly I get or how much I tickle him. I am thankful that he appreciates my cooking...and really seems to enjoy it. I am so thankful for his continuous encouragement and support through school or other problems that I face. I am very thankful he is always there for me, no matter what. Period. I am thankful that he is so kind and loving. He has turned my life upside-down in the last 6 years (for which I am so grateful). I am excited for our future together. :)

Japanese cuisine

This past week, I attempted to make my first Japanese meal. I have never tried to do this before now. I made a trial run on Wednesday and it turned out marvelously! The real run was today, with Jon. This is where I find out if it's a keeper or not. (He claims that it is and he'll gladly eat it again.)

So, a friend posted this recipe on her blog this week and I thought it sounded delicious. I like Japanese and Chinese cuisine -- but I'm very picky about what I will eat. Basically, my food choices are sweet and sour chicken and hibachi chicken. What I made this week and today, hibachi chicken (definitely an Americanized version...but close enough).

What you need:

• chicken
• soy sauce
• teriyaki sauce
• rice
• eggs
• vegetable oil
• veggies you might like (zucchini, squash, etc are suggestions from her -- Jon and I don't like many veggies)
• white sauce (also called seafood sauce)

How you do it:

1. Cut up chicken into bite-sized pieces. Prepare a hot skillet with vegetable oil and cook chicken half way. Then, add teriyaki sauce and simmer on low until the chicken is completely cooked. (She recommends covering the skillet while cooking in the sauce. I don't have one with a lid and it worked fine without it.)
2. Cook up the amount of rice you would like. (She recommends "day-old" rice. I made mine fresh and it worked fine.) Mix in soy sauce to taste. (Adds flavor and color to the dish.)
3. Scramble 2 eggs in a frying pan. Once finished, mix it in with the rice.

To serve it up:

• Plate some rice.
• Top with chicken.
• Top that with white sauce.

Then enjoy! I found it delicious and I hope you do the same.

Deoxyribonucleic acid

DNA.

It is a complex code of our genetic material that can predict most of who we are, particularly physical characteristics (emotional, personality and mental characteristics are more "nurture" than "nature").

DNA sample

So, what is it's physical structure?

This is a structure called a "double helix". A double helix is a pair of parallel helices intertwined about a common axis. Great...but what is a helix? That is a curve that lies on the surface of a cylinder or a cone and cuts the element at a constant angle. Still confused? The way I think about it is a ladder that is wrapped up into a coil. Here is an artists rendering of a piece of DNA.

See what I mean? So what is it's purpose?

Bad dreams

I tend to have dreams on a regular basis when I sleep. I kind of enjoy them. However, the last two nights, I have had bad dreams. Every once in a while, I will have a bad dream but rarely back-to-back like this. I woke up from them, both nights, in a panic and with my bed coverings...well...not on the bed. Frustrating as can be. And I won't tell you what they were about but I'll give you the subject heading: work.

Upon doing a little research as to why people have bad dreams, I came across these things.

One website lists six major reasons why people have bad dreams. At the top, anxiety and stress. However, they claim that this is primarily linked to stemming from a traumatic life event such as witnessing something horrific or the loss of a loved one. The second reason is spicy foods. This one surprised me. They cite a study done with men who ate spicy food before bed on some evenings and did not on others. The study indicates that the nights they ate the spicy food, they spent more time awake and got less restful sleep. The explanation they provide is that spicy foods can elevate the body's temperature, thus yielding disruption in sleep. (Though, I'm thinking it was probably heartburn that kept them up.) Thirdly, the fat-content of foods. Through a study not named, the research indicated that the higher fat content you consume throughout the day, the greater the chance your sleep will suffer (both quantity and quality). A second study showed that those who ate organic food had different dreams than those who ate "junk food". (I might argue two different kinds of people with different mind sets on life, etc, will have differing dreams.)

Cooking and baking binge

I have said before that I love to cook and bake. My awesome boyfriend eats (so far) whatever I put in front of him so I try to attempt new things every now and again. Although I'm my worst critic, it's nice to have another opinion to say that "yes, this was terrible" or "no, you're just being silly."

Today, I went on a cooking and baking binge. And it was fun! I made something new: red potato and green bean salad. I kinda like it. It's different from the "typical" potato salad that I grew up eating (mayo or dressing base). This one has an oil and vinegar base. Different but good. I told Jon he has to try it tomorrow to see how it really tastes.

Here's a look at the finished product...yummy!

If I could live anywhere in the world

I have been told by someone (*cough cough* my boyfriend *cough cough*) that I have not blogged since Monday and that it is time for me to post something new. So, going to a random topic generator, I have come up with this topic for this post: if I could live anywhere in the world, where would it be?

I don't have a geographic place that I can point to and say "yes! That's where I want to live." What I can do it give you the characteristics of my ideal place to live:

• Moderate temperatures -- I don't like 90 and 100 degree weather and I don't like when it gets below freezing in October and there's a threat of snow. If I could live somewhere that had a year-round temperature between 50 and 70, I would like that.
• Nearby beach -- I like the beach. I would like to live where I could easily access it, preferably in less than an hour.
• Nearby mountains -- I enjoy the mountains and being able to escape to some cooler weather every now and again. Maybe an hour to be able to get there too.
• Suburban/semi-rural life -- I do not like living in a rural country area with nothing nearby. I would be pleased with having a bit of land for my house to sit on but I want to be able to access the convenience of a town with amenities.

I think that's all I can really come up with right now. But it's a good start for where I want to live. Now, if only I can find it...

The point of exhaustion

I think I've reached it...and I still have 4 1/2 weeks to go in my semester. I just hope this doesn't mean that I'm getting sick.

See, this past weekend, I drove home and worked a mere 12 hour shift. There was nothing special about the shift (unless you count visiting Central Prison "special"). It wasn't really busy by normal standards for a downtown shift. I went home not being tired. Slept both Friday and Saturday night very well...even got an extra hour of sleep on Saturday night. Then, I drove back to Boone on Sunday afternoon. However, on the drive back, I got unusually tired. I remained tired throughout the evening. I slept throughout the night very solidly and woke up still tired. I was up for maybe 2 hours before I fell asleep on the couch for a nap (about 2 hours worth). And then, I went to class...and tried to fall asleep. And then, I went to take a test...and we'll see how that went.

And now, it's not even 7pm...and I think I'm going to head off to bed. Good night.

I'm getting Jon a fish

...or not.

I'm leaving to go home for the weekend while my wonderful boyfriend is staying in Boone. We were discussing how bored he'll be without having company to come and pester him and come over to wake him up in the morning (or, really, the afternoon) and tickle him and make meals for him. I told him that he needs a cat so he has some company when I'm away. He said no to the cat (and I'm not sure his rental company allows pets in his units, anyway).

I told him he's getting a fish. However, he says he is a fish-murderer. He can't keep them alive. That, or he chooses one that is preggers big time. I mean, there's no in between for this guy.

Essentially, it seems as though he's going to kill it or find one that is "procreation happy".

I love to cook

I really love to cook. And, thankfully, Jon likes to eat. He is rather gracious when the new recipe I am trying doesn't quite turn out right. He has eaten everything I have put before him. (Honestly, I'm amazed at that.)

Something I enjoy cooking (a genre of food, if you will) is stews and soups. Typically, they are pretty easy and end up tasting really good. I made a stew on Sunday and it turned out rather deliciously. I thought I'd share my "recipe" (of sorts). It's a rather loose recipe because I don't measure how much I put in there. (And between Jon and I, we are somewhat picky eaters...so there are only a few vegetables included in it. For what it's worth, here you go:

• Stew meat
• Potatoes
• Carrots
• Beef broth
• Tomato sauce
• Basil
• Salt
• Pepper
• Flour

First, take the stew meat and coat it in the flour. Put the meat in a lightly oiled pan on medium heat and flip after about 2 minutes and let it sit on the other side for about 2 minutes. Remove from the pan and set aside. Let it cool for a few minutes and then slice the meat into smaller bits if you prefer.

Potatoes and carrots need to be peeled and sliced. These are cut into bite-size pieces for a few reasons (easier to eat...and they cook quicker). Here is where you can go two ways...

The first is cooking in a slow cooker. Put the vegetables and meat into the slow cooker. Use about 4 cups of beef broth in the cooker. I use a medium-sized can of tomato sauce. Add that at this point. Add spices to your liking. I like a lot of basil and pepper and very little salt (if any). Cook on low for about 6-8 hours, or, if you're short on time, you can cook it on high for about 4 hours.

The second and much quicker way is to cook it on the stove top. Again, add all the ingredients listed for the slow cooker method. Bring the stew to a boil and let it continue to boil for about 45 minutes to an hour and then let simmer until you are ready to eat.

If you are more of a veggie-lover, try adding some peas or green beans and part of an onion. Although, unless  you're looking for a veggie soup, I wouldn't add too many veggies.

Hope this helps you make a delicious meal that you and your family will love. Enjoy!