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.)