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Everything Hurts: <p><a class="tumblr_blog" href="http://surrealmeds.tumblr.com/post/142233787697">surrealmeds</a>:</p> <blockquote> <p><a class="tumblr_blog" href="http://medicinethings.tumblr.com/post/141957804936">medicinethings</a>:</p> <blockquote> <p>Isquemia Intestinal/ Intestinal Ischemia</p> </blockquote> <p>I always keep this on my DDx for abdo pain. I know it’s rare, but I’ve seen it twice in my short career. </p> <p>Things I look out for:</p> <p>1. vasculopaths - has this patient had a stroke, an MI, DVT? Do they smoke? Are they diabetic or had gestational diabetes? Do they have HIV, rheumatoid disease? A combination of these? Is this a preemie baby? I always get extra suspicious for these folks. </p> <p>2. Is the pain out of proportion to the physical exam? You’ll know if you bump the stretcher and the patient grimaces like you punched them in the gut. Another way to check for shake tenderness is to ask the patient to puff their belly out to touch your hand a few inches above their abdomen, or ask how the ride over was. If everything hurts, be alert for a surgical abdomen. </p> <p>3. Are their vitals telling you something? Hypotension +/- tachycardia +/- fever = sepsis. Start hydrating right away. Don’t be fooled by numbers that are altered by meds like betablockers, ibuprofen, acetaminophen. </p> <p>4. Because I’m in a teeny hospital, if my physical exam looks sketchy, and my index of suspicion is high, I’m getting stat labs, checking the weather, and getting ready to transport my patient. Do an abdo 3 views to look for free air or megacolon. Look for elevated WBC, lactate, CRP. Do a urinalysis too. </p> <p>This hurts. It’s a horrible way to die. It gets missed, especially in women. It’s one of the diseases that early detection really can save a life because the surgeon can get rid of the jerky piece of bowel before things get out of control. Be aware that it exists and keep it on your differential. I usually find out with the plain films the patient is FOS and has a low pain tolerance, but then I get to stop everything there and give large amounts of lactulose. Easy peasy. </p> <p>(This has been my unsolicited opinion.)</p> </blockquote>
Everything Hurts: <p><a class="tumblr_blog" href="http://surrealmeds.tumblr.com/post/142233787697">surrealmeds</a>:</p>
<blockquote>
<p><a class="tumblr_blog" href="http://medicinethings.tumblr.com/post/141957804936">medicinethings</a>:</p>
<blockquote>
<p>Isquemia Intestinal/ Intestinal Ischemia</p>
</blockquote>
<p>I always keep this on my DDx for abdo pain. I know it’s rare, but I’ve seen it twice in my short career. </p>
<p>Things I look out for:</p>
<p>1. vasculopaths - has this patient had a stroke, an MI, DVT? Do they smoke? Are they diabetic or had gestational diabetes? Do they have HIV, rheumatoid disease? A combination of these? Is this a preemie baby? I always get extra suspicious for these folks. </p>
<p>2. Is the pain out of proportion to the physical exam? You’ll know if you bump the stretcher and the patient grimaces like you punched them in the gut. Another way to check for shake tenderness is to ask the patient to puff their belly out to touch your hand a few inches above their abdomen, or ask how the ride over was. If everything hurts, be alert for a surgical abdomen. </p>
<p>3. Are their vitals telling you something? Hypotension +/- tachycardia +/- fever = sepsis. Start hydrating right away. Don’t be fooled by numbers that are altered by meds like betablockers, ibuprofen, acetaminophen. </p>
<p>4. Because I’m in a teeny hospital, if my physical exam looks sketchy, and my index of suspicion is high, I’m getting stat labs, checking the weather, and getting ready to transport my patient. Do an abdo 3 views to look for free air or megacolon. Look for elevated WBC, lactate, CRP. Do a urinalysis too. </p>
<p>This hurts. It’s a horrible way to die. It gets missed, especially in women. It’s one of the diseases that early detection really can save a life because the surgeon can get rid of the jerky piece of bowel before things get out of control. Be aware that it exists and keep it on your differential. I usually find out with the plain films the patient is FOS and has a low pain tolerance, but then I get to stop everything there and give large amounts of lactulose. Easy peasy. </p>
<p>(This has been my unsolicited opinion.)</p>
</blockquote>

<p><a class="tumblr_blog" href="http://surrealmeds.tumblr.com/post/142233787697">surrealmeds</a>:</p> <blockquote> <p><a class="tumblr_bl...

Everything Hurts: selamorpha: little—bambi—eyes: dopeface: sever-sinner: I love her so much. fragileminded: This is me and these are my scars. August 2010, on vacation, Greece.  I’m recovering from self harm and these are my scars. They’re there. They’re visible. They always will be and I know that. I can’t go back and undo my mistakes. I used to hide my scars, always. I used to be so ashamed, I felt so ugly and disgusted with myself. People who say self harmers do it for attention? You have no idea of how far we go to cover it up, to conceal the truth, to keep it a secret, to keep it from you.  I regretted my mistakes for years. You know what that does to you? It makes you bitter. It makes you sad. It makes you lonely and miserable. It makes you push people away because you’re so ashamed. Everything hurts. Breathing hurts, living hurts, existing hurts and what hurts the most - to go on. To keep breathing, to keep living.  But you know what? I’m still me. I always have been. My skin might be damaged and yes, it’s self inflicted - but what difference does it make? The people who love me, they love me for me. Flaws doesn’t make them love me any less. My scars are a part of me. My scars made me who I am. People who can’t handle that - they’re free to leave. Friends who left? I let them leave. If I’m not good enough for them because I cut, that’s not my loss.  That’s shallow. Everyone has flaws. Everyone has a story. If people want to judge me based on how I look, go ahead. Are you perfect? Are you sure about that? Have you never done anything in your life you wish you could go back and change? Are you flawless? Really?  Because I’m not, and I know that.  i respect you, a lot respect and love <3
Everything Hurts: selamorpha:

little—bambi—eyes:

dopeface:

sever-sinner:

I love her so much.
fragileminded:

This is me and these are my scars. August 2010, on vacation, Greece. 
I’m recovering from self harm and these are my scars. They’re there. They’re visible. They always will be and I know that. I can’t go back and undo my mistakes. I used to hide my scars, always. I used to be so ashamed, I felt so ugly and disgusted with myself. People who say self harmers do it for attention? You have no idea of how far we go to cover it up, to conceal the truth, to keep it a secret, to keep it from you. 
I regretted my mistakes for years. You know what that does to you? It makes you bitter. It makes you sad. It makes you lonely and miserable. It makes you push people away because you’re so ashamed. Everything hurts. Breathing hurts, living hurts, existing hurts and what hurts the most - to go on. To keep breathing, to keep living. 
But you know what? I’m still me. I always have been. My skin might be damaged and yes, it’s self inflicted - but what difference does it make? The people who love me, they love me for me. Flaws doesn’t make them love me any less. My scars are a part of me. My scars made me who I am. People who can’t handle that - they’re free to leave. Friends who left? I let them leave. If I’m not good enough for them because I cut, that’s not my loss. 
That’s shallow. Everyone has flaws. Everyone has a story. If people want to judge me based on how I look, go ahead. Are you perfect? Are you sure about that? Have you never done anything in your life you wish you could go back and change? Are you flawless? Really? 
Because I’m not, and I know that. 


i respect you, a lot

respect and love <3

selamorpha: little—bambi—eyes: dopeface: sever-sinner: I love her so much. fragileminded: This is me and these are my scars. August...