littlemissdoyourpart
Get excited about the little things. About wearing a new outfit for the first time. About Sunday brunches with your best friends. About the new cute guy in your class. About finding an extra dollar in your pocket. About anything that even remotely makes you happy because as you grow up, passions fade and enthusiasm gets mistaken for foolishness. So don’t let the grey world stop you from shining.

note to self (via vanillapagesandink)

… If other people don’t get excited by this kinda stuff that makes me feel weird, like I’m a really overly excitable person

(via meetyourinnerstrength)

Need to keep reminding myself

(via fitspoholic)

You know that anxiety that you get when you have a lot of things to do, and then you drink coffee and you can feel your heart rate pounding in your chest…

Yeah, that’s happening to me right now.

This 22 year old biology major was not meant to be in charge of a family business.  Just saying.

**sings, “daddy come back” in the “baby come back” tune**

pre-pa-girl

pre-pa-girl:

A situation came up at one of my church functions that has had me thinking a lot about gender roles.

An elderly lady fell on to the floor from her chair outside, and when I came outside, all I saw was people huddled around her on the ground. When I walked up, my first question, “Is she…

Because I still feel very strongly about this…. Reblog.

supergirlpa-s
whereismystethoscope:

dieselotherapy:

Skill: assessing pupil response.
Lets look a little closer at this particular skill.
First up, the pupil isn’t actually anything at all. A hole at the centre of the iris that controls the amount of light entering the eye. The size of this hole is controlled by 2 muscles within the iris. The pupilloconstrictor (controlled by the parasympathetic nervous system) and the pupillodilator (controlled by the sympathetic nervous system). So I guess what we are really assessing here is the iris response.
Pupil contraction (parasympathetic response):
When a light intensity increases across the rods and cones of the retina, impulses travel via the optic nerve to the pretectal nucleus of the upper midbrain.
From here impulses travel to the Edinger-Westphal nucleus, and onwards via the III cranial nerve (occulomotor) to the pupilloconstrictor muscle of the iris… causing contraction (miosis).
Pupil dilation (sympathetic response):
When light intensity decreases, impulses travel from the retina via the optic nerve to neurones on the hypothalamus where it takes a convoluted neuronal journey through the lateral brainstem to the spinal cord, down across the apex of the lung, back up alongside the internal carotid into the skull, through the inferior orbital fissure. Finally, it travels along the V cranial nerve (trigeminal) that innervates the pupillodilator muscle of iris… causing dilation (mydriasis).
How to assess pupillary reflexes.
Ideally, pupillary reflexes should be examined in a dim environment. If the patient is conscious, ask them to fix their gaze on a target some distance behind you ( If they re-focus on you or your torch, there may be pupil constriction as a result of accomodation).
Use a neurotorch or cheap penlight torch. This is for 2 reasons:
Using a superbright concentrated light will not be appreciated by a conscious patient.
Doctors do not (as a rule) carry neuro torches. They borrow the nurses. They forget to give them back.
Size and Equality.
The pupil size is documented as the diameter in millimetres. Tools to help you estimate this size include pupil gauges located on most Glasgow Coma Scale records and many neuro torches.
You may also find it useful in your written documentation to include descriptors such as: pinpoint, small, midposition, large, dilated.
Aniscoria: Up to 20% of the population have a slight difference in pupil size and is considered a normal variant. This difference should not be greater than 1mm and pupil reactivity should be normal.
Shape:
The pupil shape can be documented as round, irregular, oval or keyhole. Causes of irregular pupils include cataract surgery or the implantation of intra-occular lenses.
Oval pupils may be a result of compression of the III cranial nerve as a result of raised intracranial pressure (ICP). As ICP increases, the pupil will continue to dilate and eventually become non-reactive to light.
Keyhole pupils are seen in patients post iridectomy (a common part of cataract surgery). They may still react to light but usually the reactivity is sluggish.
Reactivity:
The pupil response to light is assessed by shining a neuro torch (or low powered penlight torch) separately into each eye. Tip: shining the torch onto the pupil from directly above may make assessment difficult due to ‘glare’ reflected off the cornea. Instead, position yourself in front of the eye and shine the beam from slightly off to one side.
Document pupil reactivity to light separately.Reactivity may be:
Brisk
Sluggish
Non-reactive.
At the same time look for the normal pupillary constriction response in the opposite eye. This is called the consensual pupillary response.
Accommodation:
This is the normal constriction of the pupil that occurs when a conscious patient is asked to shift their focus from a distant object, to a close one.
Causes of abnormal pupils:
Unequal pupils:
Mydriasis: One pupil is dilated and non-reactive whilst the other is normal. May be caused by compression of the III cranial nerve, compression of the posterior communicating artery or by direct damage to the nerve endings in the iris sphincter muscle.
Following a traumatic brain injury an increase in intracranial pressure can lead to the uncus (part of the temporal lobe) squeezing against the tentorium and pressing against the III cranial nerve resulting in a dilated pupil (mydriasis) on the affected (ipsilateral) side.If pressure continues to increase, contralateral dilation will also occur.
Horner’s Syndrome: One pupil is smaller than the other and has a decreased response to light and accommodation. There is ptosis of the eyelid on the affected side. Caused by loss of sympathetic intervention to the pupil due to a lesion in the brainstem of spinal cord, or damage to the hypothalamus. There is also decreased sweating (Anhidrosis) of some or all of the face. Causes of Horner’s syndrome include carotid artery dissection, nasopharyngeal tumours, brachial plexus injury.
Dilated pupils:
Drug induced mydriasis: bilateral dilation as a result of drugs including antihistamines, hallucinogens, amphetamines, anticholinergics, dopamine or barbiturates. May be caused by medication used for ophthalmic examination such as atropine, scopolamine, or by anoxia or brain death.
Mental or emotional stimulation: Dilation may also be caused by sexual arousal or increased mental effort.
Constricted pupils
Miosis: Bilateral pinpoint pupils (usually too small to figure out if they are responding to light or not). May be caused by disruption to the sympathetic pathway due to intraocular inflammation or direct trauma, a pontine haemorrhage, or due to the effect of drugs such as opiates, pilocarpine or acetylcholine.
Equal pupils:
Hippus: Initially react to light but then alternate between dilated and constricted. May indicate early compression of III cranial nerve. May indicate injury to the midbrain or barbiturate toxicity.
Relative Afferent Pupillary Defect (RAPD): When light is shone into the effected eye there is a sluggish reaction. There is a normal consensual reaction when light is shone into the opposite eye, but when the light is quickly shone back to the effected eye it will dilate. This is known as the swinging flashlight test (see video below) and may indicate optic neuritis, retinal detachment or infection or direct optic nerve damage.
In conclusion, a pupil assessment is a quick but important skill that can give a great deal of information. The eyes may indeed be the windows to the soul. But the pupils are the manholes to the ongoing neurological status of your patient.
(x)
 

Awesome post! Thank you!

whereismystethoscope:

dieselotherapy:

Skill: assessing pupil response.

Lets look a little closer at this particular skill.

First up, the pupil isn’t actually anything at all.
A hole at the centre of the iris that controls the amount of light entering the eye.
The size of this hole is controlled by 2 muscles within the iris.
The pupilloconstrictor (controlled by the parasympathetic nervous system) and the pupillodilator (controlled by the sympathetic nervous system).
So I guess what we are really assessing here is the iris response.

Pupil contraction (parasympathetic response):

When a light intensity increases across the rods and cones of the retina, impulses travel via the optic nerve to the pretectal nucleus of the upper midbrain.

From here impulses travel to the Edinger-Westphal nucleus, and onwards via the III cranial nerve (occulomotor) to the pupilloconstrictor muscle of the iris… causing contraction (miosis).

Pupil dilation (sympathetic response):

When light intensity decreases, impulses travel from the retina via the optic nerve to neurones on the hypothalamus where it takes a convoluted neuronal journey through the lateral brainstem to the spinal cord, down across the apex of the lung, back up alongside the internal carotid into the skull, through the inferior orbital fissure. Finally, it travels along the V cranial nerve (trigeminal) that innervates the pupillodilator muscle of iris… causing dilation (mydriasis).

How to assess pupillary reflexes.

Ideally, pupillary reflexes should be examined in a dim environment.
If the patient is conscious, ask them to fix their gaze on a target some distance behind you ( If they re-focus on you or your torch, there may be pupil constriction as a result of accomodation).

Use a neurotorch or cheap penlight torch. This is for 2 reasons:

Using a superbright concentrated light will not be appreciated by a conscious patient.

Doctors do not (as a rule) carry neuro torches.
They borrow the nurses.
They forget to give them back.

Size and Equality.

The pupil size is documented as the diameter in millimetres. Tools to help you estimate this size include pupil gauges located on most Glasgow Coma Scale records and many neuro torches.

You may also find it useful in your written documentation to include descriptors such as: pinpoint, small, midposition, large, dilated.

Aniscoria:
Up to 20% of the population have a slight difference in pupil size and is considered a normal variant. This difference should not be greater than 1mm and pupil reactivity should be normal.

Shape:

The pupil shape can be documented as round, irregular, oval or keyhole.
Causes of irregular pupils include cataract surgery or the implantation of intra-occular lenses.

Oval pupils may be a result of compression of the III cranial nerve as a result of raised intracranial pressure (ICP).
As ICP increases, the pupil will continue to dilate and eventually become non-reactive to light.

Keyhole pupils are seen in patients post iridectomy (a common part of cataract surgery). They may still react to light but usually the reactivity is sluggish.

Reactivity:

The pupil response to light is assessed by shining a neuro torch (or low powered penlight torch) separately into each eye.
Tip: shining the torch onto the pupil from directly above may make assessment difficult due to ‘glare’ reflected off the cornea. Instead, position yourself in front of the eye and shine the beam from slightly off to one side.

Document pupil reactivity to light separately.
Reactivity may be:

Brisk

Sluggish

Non-reactive.

At the same time look for the normal pupillary constriction response in the opposite eye. This is called the consensual pupillary response.

Accommodation:

This is the normal constriction of the pupil that occurs when a conscious patient is asked to shift their focus from a distant object, to a close one.

Causes of abnormal pupils:

Unequal pupils:

Mydriasis: One pupil is dilated and non-reactive whilst the other is normal.
May be caused by compression of the III cranial nerve, compression of the posterior communicating artery or by direct damage to the nerve endings in the iris sphincter muscle.

Following a traumatic brain injury an increase in intracranial pressure can lead to the uncus (part of the temporal lobe) squeezing against the tentorium and pressing against the III cranial nerve resulting in a dilated pupil (mydriasis) on the affected (ipsilateral) side.
If pressure continues to increase, contralateral dilation will also occur.

Horner’s Syndrome: One pupil is smaller than the other and has a decreased response to light and accommodation. There is ptosis of the eyelid on the affected side.
Caused by loss of sympathetic intervention to the pupil due to a lesion in the brainstem of spinal cord, or damage to the hypothalamus. There is also decreased sweating (Anhidrosis) of some or all of the face.
Causes of Horner’s syndrome include carotid artery dissection, nasopharyngeal tumours, brachial plexus injury.

Dilated pupils:

Drug induced mydriasis: bilateral dilation as a result of drugs including antihistamines, hallucinogens, amphetamines, anticholinergics, dopamine or barbiturates.
May be caused by medication used for ophthalmic examination such as atropine, scopolamine, or by anoxia or brain death.

Mental or emotional stimulation: Dilation may also be caused by sexual arousal or increased mental effort.

Constricted pupils

Miosis: Bilateral pinpoint pupils (usually too small to figure out if they are responding to light or not).
May be caused by disruption to the sympathetic pathway due to intraocular inflammation or direct trauma, a pontine haemorrhage, or due to the effect of drugs such as opiates, pilocarpine or acetylcholine.

Equal pupils:

Hippus: Initially react to light but then alternate between dilated and constricted.
May indicate early compression of III cranial nerve.
May indicate injury to the midbrain or barbiturate toxicity.

Relative Afferent Pupillary Defect (RAPD): When light is shone into the effected eye there is a sluggish reaction. There is a normal consensual reaction when light is shone into the opposite eye, but when the light is quickly shone back to the effected eye it will dilate.
This is known as the swinging flashlight test (see video below) and may indicate optic neuritis, retinal detachment or infection or direct optic nerve damage.

In conclusion, a pupil assessment is a quick but important skill that can give a great deal of information.
The eyes may indeed be the windows to the soul. But the pupils are the manholes to the ongoing neurological status of your patient.

(x)

 

Awesome post! Thank you!

cranquis

Anonymous asked:

You only got into medschool because you're hot and teachers want to bang you before you fail out. I hope you're researching secretary positions by now it won't be long.

coffeemuggermd answered:

😂

And I hope you’re not a scientist you know, making all these claims and predictions based on no evidence.

No worries I won’t screw you up when you’re on my operating table.

😂

cranquis:

aspiringdoctors:

pleasedotheneedful:

—dopamine:

Best way to react to anon hate.

there’s a lot of weird anon hate infiltrating medblr, directed at women. probably the same one or two dudes imho

anyway bro your mindset is about 50 years behind the times.

Dear Greyface hating on my medblr buddy:
I’m not as nice as coffeemuggermd.

You know one of the my most vivid memories of things I did in gross anatomy lab? Dissecting the testicles.

You do that by making an incision near the top of the scrotum, fishing down with your fingers in the nutsack to clear away all the fascia suspending the testicles, and then pulling them out of the incision and letting them dangle by the spermatic cord and vessels. It looks like a hard boiled egg until you dissect the outer covering.

Think about that before you start insulting lady medical professionals, ok pal?

image

Love,

AspDocs and probably everyone else

Since the testicular-related threats have already been appropriately doled out, let me address some of the underlying stupidity in Greyface’s message:

  1. Med school teachers do not have any impact on whether you get accepted or not — there’s a special application committee which determines that.
  2. Even if you’re smoking hot, that fact doesn’t get you an interview for (much less get you ACCEPTED to) med school — it actually takes a lot of hard work, time investment, and yes intelligence in order to have all the qualifications to just get past the first round of applications.
  3. Let’s pretend that this theoretical “horny med school admissions committee” DID accept you to med school primarily because they want to “bang you” — well, they certainly wouldn’t accept you if they thought that you would fail out of med school (before OR after this theoretical big bang). Because the last thing they want is for a hole to open up in their class (LANGUAGE??!), with all the scheduling/financial chaos that causes (for the student body, not just the failed student).

(Annnnd right now somewhere in Southern California, a screenwriter is frantically scribbling “Horny Med School Admissions Committee” on a napkin…)

OH — one last thing, Greyface — here’s the definition of psychological projection. Cuz that’s what you’ve got going on… jerk.

*not wasting a gif on this loser*