Drastic and devastating

Drastic and devastating

The title of this post presents two important words from the medical dictionary. “drastic” can be first seen in the homeostasis introduction to medical physiology course. It emphasizes the lack of adaptive and accommodative responses to sudden and strong changes in the environment. In such conditions the outcome can be quite damaging or even fatal. The word “devastating” can be found in the pathology essays such as those changes due to severe infections and it usually concerns a local pathological change, e.g. necrosis. Though the two words may originally concern natural events in the environment, they may provide clues to medical care and case evaluation.

In medical practice the care-giver should avoid harsh interventions in terms of course and dose. The treatment may be better doing when it is decent and incremental (opposite to drastic). That view in the medical care – in some situations – entails ‘partial correction’ of the concerned disorder as”rapid*” ‘full correction’ may bring about quite unwanted or even fatal hazard. It is always wise to have an overall vision of the medical case with top-to-bottom estimate so that such extreme flip-flops can be better appreciated and avoided. The treatment should be both problem- and patient-tailored. As the body’s reserves to accommodate changes (temperature, water, food, etc.) is limited and varying from time to time one should be careful not to be too rush or too slow.

By the way, the medical opposite of devastating can be ‘mild’ or ‘trivial’.

Take-home massage:

1- Be decent, systematic, and incremental.

2- Observe well.

3- Be open-minded, generous and evolution-ready.

4- Make your expectations as modest and small as you can.


* Suggested steps of management could be:

1- Reverse the current event.

2- Restore/establish base line.

3- Treat residual illness.



The physician’s guide

the physician's guide

The physician’s guide is an indispensible tool to summarize basic medical and clinical knowledge and experiences. It should be concise, easily demonstrable, regularly updated and greatly physician-specified (self made).

Here is a personal view of such important medical tool.

The Hippocratic Oath

Section 1: normal values (pediatrics: growth milestones or curves, caloric and fluid requirements and calculations; CBC; hemoglobin electrophoresis; plasma electrophoresis; liver function; kidney function; urine; stools; semen; hormones; electrolytes; arterial boold gases; and ECG findings).

Section 2: preparation-oriented drug index (topical formulas: skin, eye, ear, and nose; tonics and food supplements; antimicrobials: antiseptic, antibiotic, antifungal, antiprotozoal, and antihelimenthics; analgesics and antipyretics; antihistaminics; corticosteroids; skeletal muscle relaxants; antispasmodics; antihypertensives and cardiac agents; hemostatics, hypoglycemics; neuropsychiatric agents (sedatives and hypnotics, anticonvulsants, brain stimulants, antidepressants, antiparkinsonians); and beauty preparations (shampoos, cosmetics, soaps, etc.).

Sections 3: natural foods and herbs – sorted alphabetically – and their uses (basilica, chamomile, garlic, green tea, onion, thyme, etc.).

Section 4: medicines’ doses and instructions tables (neonate, child, and adult).

Section 5: crude models of medical prescriptions (orthopedic, eye, ear, nasopharyngeal, dermal, gynecologic, oral, cardiac, digestive, liver, renal, respiratory, and neuropsychiatry).

Section 6: medical algorithms (pediatrics: infant of diabetic mother, muconial aspiration, low birth weight, prematurity, neonatal jaundice, respiratory distress, etc.; adults: HTN, DM, bronchial asthma, cardiac asthma, DVT, diabetic ketoacidosis, hypoglycemia, stroke, etc.).


The physician’s bag

the physician's bag

In alignment with the order needed for a well resolved physician a competent and feasible preparation of the physician’s bag should be realized. This process entails a thorough understanding and mastering of the commonest medical problems that may be a matter of urgency or emergency. Here are some of these cases arranged according to their relative frequency rather than their emergency level:

  1. Fainting or syncope: – let the person feel that he/she is attended, e.g. hold the arm and ask about how he/she is now, while feeling the radial pulse. – apply the ABC scheme (air way, breathing, and circulation). – notice the colors, odors, sweating, tremors or special positions, if any. And – take the vital data (pulse, blood pressure and temperature). Manage accordingly.
  2. Anxiety bouts (attacks): – reassure the person that he/she is attended, i.e. appropriate care can be available. – notice pulse rate, hand sweating and temperature. – try to encourage the person to talk about some topics like the type of food, sports, books he/she likes and if he/she have certain fears or current personal problems. – discuss the possibility of immediate treatment, e.g. with a beta blocker (nonselective), and outline a management plan that can multidimensional, e.g. physical, dietary and/or medical.
  3. Hammering headaches: – reassure the person that the case is not serious. – take the vital data (pulse, blood pressure and temperature). – ask the person if he/she is taking any medications or if there is (are) some chronic illness (es). – encourage the patient to drink normal water after making sure there would be no risks (e.g. the person can swallow normally, no intoxication by a corrosive substance for example, no water restriction, etc.). Manage accordingly.
  4. Fever: – reassure the person that the case is not serious. – ask about specific pain or other complaints, e.g. diarrhea or colic. – if this would seem conservative and neutral, encourage the person to drink normal water, fresh juice like lemonade and orange that have the same temperature as that of the environment. – take the vital data and notice the colors, odors, sweating, tremors or special positions, if any. Manage accordingly.
  5. Renal colic: – reassure the person. – the typical renal colic follows the course of the renal system on either right or left side, i.e. the loin region, the ureter and the urethra. – ask for a precipitating factor, e.g. drinking water problem, unbalanced food intake, exposure to cold, or stress. – take the vital data and notice the colors, odors, sweating, tremors or special positions, if any. Manage accordingly.
  6. Chemical intoxication: – reassure the person. – take the vital data and notice the colors, odors, sweating, tremors or special positions, if any. – after withdrawal or avoidance of the intoxicating agent the condition resolves gradually and steadily over time. Manage accordingly.
  7. Difficult breathing (asthma): – reassure the person. – ensure good ventilation of the room, e.g. open the windows. – notice the colors, odors, sweating, tremors or special positions, if any. – assess for ABC. – notice lower limb edema, abdominal enlargement and or tenderness, neck vein pulsations. – auscultate the chest for abnormal inspiratory or expiratory sounds. – consider possible heart and or lung diseases. Manage accordingly.
  8. Bleeding nose (epistaxis): – reassure the person. – let the person breath by his/her mouth and then compress the nasal cartilages against the nasal septum from outside. – ask the person to raise his/her head little up while still closing the nose. – after the condition has stabilized, the person is advised to avoid the precipitating factors, e.g. avoiding sun burns. – notice the colors, odors, sweating, tremors or special positions, if any. And – take the vital data (pulse, blood pressure and temperature). Manage accordingly.
  9. Cut wound: – control the bleeding site by compression with clean and sterile gauze. – special wound healing plaster and or surgical stitching may be used as required.
  10. Chest pain: – reassure the patient. – risk factors include family history of coronary heart disease, hypertension, diabetes and smoking. – under medical supervision , e.g. by an ambulance, and while explaining it as being absolutely precautionary, refer the person to the nearest hospital or an intensive care unit for best medical care.

The physician’s bag contents include:

  1. Physician’s guide.
  2. Physician’s stationary: a prescription or note-block, pen, plastic ruler (about 10 cm length).
  3. Medical disposables: 3- 5 plastic examination gloves, 2-5 sterile scalpels, 2-5 sterile plastic syringes (1, 3, and 5 ml), 1-3 i.v. canulas (small and medium), medical cotton and gauze, and 2-5 tongue depressors and sterile surgical needle.
  4. Medicines and medical stuffs: ampoules and tablets (atropine, theophylline, antihistamine, NSAID, corticosteroid, hyoscine, nonselective beta blocker), and surgical betadine.
  5. Apparatuses and instruments: stethoscope, sphygmomanometer, torch, thermometer,  needle holder and arm tourniquet.

The ten golden rules in rescuing the (medically) troubled

ten golden rules

Situations in which medical care or advice should be provided vary considerably as regard place, time and the extent of the medical problem, i.e. patient’s state as regard consciousness, cooperation, presence of patient’s relatives, etc.

Here are 10 rules that I wish to conclude from my experience in the clinical field.

1- The sense of being attended: the health care provider should stress and make sure that the patient perceives that a good medical care is being present. This would be achieved by speaking gently and confidently with the patient and/ or with the relatives. The doctor may state clearly that he/ she would have no problem to see the patient for free when the patient’s condition money-wise is not favorable. The doctor should be cautious as much as possible to protect the patient from possible negligence by his/ her relatives.  In case of a patient with perturbed consciousness the doctor would call the patient by his/ her name (if known) and hold the patient hand warmly.

2- Resort and handing: the doctor would have preliminary assessment of the medical problem, and recalls his/ her knowledge and may need to find some source as a book or contact a colleague for consultation. The doctor may have to urge for a referral to a more experienced doctor.

3- Fulfilling continuum: the doctor may inspire that human body is one continuum with dynamically operating modes and proportionately distributed components. This should be very useful in determining the dose, rate, and intervals of the medicines to be used.

4- Hierarchical approach: the management plan should be almost clear from the beginning. The management should assume a hierarchical concept as regard the relevance of interventions/medicines to one another from one side and to the human body function from the other side. It should start from natural means to encourage the self-curing power in the patient, e.g. warming the patient, changing posture, etc., and proceeding from a less invasive to more invasive.

5- Multi-footed treatment: this means that using more than one point or target in the treatment, if allowable, would help reach a more smooth response with less likelihood of misfortune. This integrated approach would allow less and more tolerable medicine doses.

6- Proof tracking:  this means that on following certain treatment the doctor keeps an open eye checking back and forth for the consistency and appropriateness of a given step in the management for a possible need to change the treatment plan.

7- Case cliché: by the time the medical condition is being resolved the doctor should formulate a clear definition of the case (diagnosis) and inform the patient or the relative(s), orally and/ or in writing.

8- A Gift-outcome-art: this means that the outcome of the medical care is quite unforeseeable. Here, the outcome is usually expressed as percentages or probabilities and not as a definitely individualized result.

9- Non obligation: the medical care should not bear any obligation from both patient’s and doctor’s side.

10- Medical ethics: the doctor should be aware of and fulfilling the medical ethics applicable to the particular medical problem being managed.


Emotional whirl

It is not a secret to blame emotional state for one’s health problems and deranged productivity. Yet, the implication of that emotional aberrance or “whirl” may be more than it could be thought of particularly in naturally oversensitive and intellectual persons. In an extreme adoption of this emotional perspective of human health a considerably large sector of psychic, psychosomatic and mental illnesses may no longer be considered as abnormal.

A reliable key to interprete some physical complaint, e.g weakness or fatigue, or unusual feeling like lostness as being of emotional origin is that it would happen unexpectedly, i.e. out of situational context, and there could be also several unrelated complaints. For people who are unaware of such emotional basis of these health phenomena the situation may be embarrasing enough and undue management may be made, when assurance and a glass of normal water could be the best thing to offer.

An emotional whirl – as I am trying to name overflooding emotions here – may take quite different forms. The person may have insomnia, loss of appetite, some headaches, and other things one may find in a psychiatric textbook. Once possible organic (?) causes can be excluded by the qualified doctor, appropriate life style and social manibulation should be very helpful and the person enjoys a happy and productive life very proudly.