Bakit Nga Ba Tinutubo ang Pasyente? (Indications for Intubation for the Layperson)

By: Viktoria Ines Matibag, MD

Siguro naman nakakita na kayo ng mga pasyenteng nakatubo sa mga drama. Maraming maling konsepto na tinuturo katulad na lamang ng: 

1. Nagtutubo lamang ang pasyente kapag wala nang pulso, 
2. Hindi nakakapag salita ang may tubo dahil nga nasa daluyan ito ng hangin,
3. Hindi makakahinga ang pasyente kapag may tubo.

Translation: Don't mistake medical drama series in TV for the real thing. Often times, there are specific important details that is missed out in TV that if you missed it out in real life could result to patients getting harmed. These are the common misconceptions about Intubation: 

1. We only intubate patient if they are already dead or has no pulse 
2. The patient can't express himself if a patient is intubated 
3. The patient can't breathe if he/she is intubated because a TUBE is inserted down his THROAT!

Choosing a Specialty

My favorite part of my job is teaching. There, I’ve said it. Yeah, it’s cool picking apart diseases and mix-n-matching treatment regimens for the optimal balance of cure and side effect. I love hand-holding people through concepts that are far beyond their educational level and helping patients and families make impossible decisions with uncertain data.

But give me a new third-year medical student who’s been dropped in the middle of the hospital for her First Real Rotation Ever, and I am just in heaven. I love teaching med students.

One of the things I love the most is helping them figure out what flavor of doctor they want to be. Third year is all about sampling it all, and experiencing what actually happens in the various medical specialties. You rotate through Surgery. You rotate through Internal Medicine. You rotate through Family Practice. You rotate through Anaesthesia. You rotate through Psychiatry. In fourth year, you’re supposed to be narrowing it down to your most likely options for residency.

Tips on Excelling on Rotations

I know that my performance on clinical rotations is important for how I will be assessed. How can I distinguish myself?

Response from Sheila M. Bigelow, DO Resident Physician -- Pediatrics, UH Rainbow Babies and Children's Hospital, Cleveland, Ohio

Clinical rotations can be very challenging. For the first time, you're expected to follow patients, present on rounds, show your medical knowledge, and work well in a team environment with people who are new to you, knowing that you'll be moving on before long. Not only are you expected to meet the basic requirements, you are expected to do well enough to earn an honors grade or a strong letter of recommendation from the attending.

Fortunately, there are some "must know" tricks that can help you distinguish yourself and help get the grade or letter that you want.

Thinking of Quitting

Question:

Medical school and residency can be tough physically, mentally, and socially. What's the best way to get through those tough times when all I want to do is quit?

Response from Sheila M. Bigelow, DO
Resident Physician - Pediatrics, UH Rainbow Babies and Children's Hospital, Cleveland, Ohio




Depression in Medical Students

Medical school and residency are some of the biggest challenges of our careers. Along with the good, exciting times come the hard, rough times. Long hours, little sleep, and a high-stress environment all create the perfect storm. These feelings can fall anywhere in the spectrum from burnout and depression to suicidal thoughts and suicide attempts.

Ins and Outs of Being an Intern

Question

How will things change as I transition from medical student to intern?

Response from Graham Walker, MD
Chief Resident, St. Luke's-Roosevelt Hospital Center, New York, New York

As an intern, you are the primary patient data collector. It's probably the most important part of the team. Welcome to the role.

Your first days as an intern may seem like just another medical school rotation; you're still writing notes, but what you write matters much more now. Your team will rely on you to know your patients and their numbers inside out, so if you say the creatinine is trending down, it better be.

Transitioning to INTERNSHIP

In less than 60 days, I will be going into internship and most of my posts will also be transitioning about internship and hospital duty. Thanks for your continued support.

MedicalStudent soon to be MedicalIntern... Hopefully...

The Art of Expectations in the Emergency Room

This article caught my attention as an intern once relayed to me his experience in the Emergency Room wherein the patient, after all that had been done for them, complained and maligned the interns and the staff of the ER. As unfair as it may seem, the disconnect between patient's expectations against hospital protocol may well be the very reason of this incidences. Or I may be wrong... nevertheless, this article is worth reading...


The Art of (Emergency) Medicine

Jeffrey Wonoprabowo, Medical Student

I had seen the patient. I had come up with my assessment and plan. I discussed it with a senior resident and now it was time to present it to the attending. As I wrapped up what I thought was a fairly decent patient presentation, my attending asked me what the patient wanted. I stammered. What the patient wanted? Wasn’t that obvious? They come in to the Emergency Department with a chief complaint and we’re supposed to fix it. Right?

Pre-Clerkship Exposure Duty Rotations

PhotoCredit: MedObserver.Com

          Our exposure duty this year had been extended to 6 months instead of the usual 3 months as a result, I presume, of the first ever student consultation spearheaded by our first alumni dean of the college. The purpose of which is suppose to orient us and make us be prepared for our upcoming internship duties in a few months to come.
          One thing I learned about these duties are they are basically WORTHLESS. Basically we don't do anything and instead we answer to the whims of the residents on duty. We do whatever they say in the absence of real work that may prepare us for the grueling work we will do as interns. It's good for those like me who had hospital experiences during our pre-medical course but for those who haven't, it's totally a purposeless.
          For the benefit of those who would otherwise learn from these experiences, I will try to give out some tips to make it a rewarding and a learning one:

Recovering from a Bad Evaluation

Question

I received negative feedback from my most recent rotation, and I'm trying not to freak out. What should I do?

Response from Alisa R. Gutman, MD, PhD Psychiatry Resident, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania

It's no secret that medical students are used to doing things right, so there are few things as difficult as being told that you've done something wrong. Even worse is getting serious negative feedback in writing. Here are some tips for learning from a negative evaluation without letting it rewrite how you see yourself.

Weathering the Storm

It was July 1—my first day of fellowship. I was assigned to the cardiac ICU at Hopkins Bayview, the same unit where I had taken my first call as an intern and where I had run my first code.

Moments after receiving sign-out, an overhead page sounded, "CICU fellow, pick up line seven-five."

It took me a moment to realize that the call was for me. I picked up the phone.

"I'm calling from the emergency department. You need to get down here, stat. We have a patient in VT storm."

"VT storm?" I asked, with a squeezing sensation in my stomach. "Are you sure?"