Suturing Skills

As medical students we are in the business of learning. Some things are well learned on the job, others are better honed on our own and then practiced under close supervision before getting too far ahead of our skill level. 

Tying It All Together

The baby was out, the placenta delivered, and now we had to repair the laceration. When my attending handed me the loaded needle driver, I was a little hesitant as I have not yet sutured living flesh. Without a problem, I was able to approximate the wound from one side of the tear the other. Having only practiced a couple suture ties on pigs feet, I was in unfamiliar territory and I had to let my preceptor know. Sadly he finished the job I started, despite my desire to learn.

This meant I would certainly be learning more on suturing techniques that night so I could be a little more prepared should another opportunity arise. I was happily surprised at the few things I did find and would like to share them here for those who may be a beginner at the art of suturing.

• Suture Basics - Website compiled by Boston University School of Medicine
• Suture Handling Videos - Website produced by University of Pennsylvania
• Knot Tying Kit - FREE Practice kit from Ethicon (Enter your information and they will ship it to you at no cost)
• Surgical Knots and Suturing Techniques - Book written by F.D. Giddings

With another surgery coming up tomorrow, we'll see if I get a chance to wield the needle and string. If it doesn't happen, my dental floss and fruit peels will have to hold me over until my surgical rotations come around. 

Question of the Week

A 24-year-old man is involved in a motorcycle accident and loses several liters of blood. In addition to resuscitation with normal saline, physicians decide to transfuse blood products. If the patient has blood type B, Rh-negative, which of the following blood products may be most safely administered?

A. Type A, Rh-negative red blood cells
B. Type AB, Rh-negative red blood cells
C. Type B, Rh-positive whole blood
D. Type O, Rh-negative red blood cells
E. Type O, Rh-negative whole blood

Answer & Explanation

Medical Professional Attire

First impressions can only be made once. Looking professional is important for any health care provider. As students, we are not only wanting to make a good impression on the patients we see, but we have to let our attendings know that we understand playing the part also means dressing the part. 


Comfortably Dressed

For most rotations we are dressed in modest business attire adorned with the white coat, but there are some rotations where we get to dress a little more comfortably. These times are usually reserved for Surgical, OB/GYN, and Emergency rotations where procedures are common. Most hospitals will even supply cotton scrub uniforms when sterile procedures are expected. Fortunately, even when they are not readily provided, there is an expanding market offering cheap medical scrubs both online and in local stores.

Whether you are looking for medical style attire at an affordable price or simply want some cheap scrub sets to double as pajamas you don't have to look far to find them. They are easy to clean, less restricting than business garb, and you still look professional when wearing your white coat. When I first observed physicians wearing their scrubs around the hospital, I thought it was funny that the tops were always tucked into their pants. Since then I've learned that this is a distinguishing factor among physicians. As funny as it may look, it sets them apart from the rest of the crowd and reintroduces a sense of professionalism through the threads they wear. To avoid looking like a scrub, tuck your scrubs.

Question of the Week

A 6 year old girl is being evaluated for short stature. She is at the 12th percentile for height and the 34th percentile for weight. Vital signs are within normal limits. And physical exam shows widely spaced nipples and a high arched palate. Karyotyping shows 45XO. Which is she most at risk of developing?

A. Bipolar disorder
B. Breast cancer
C. Mental retardation
D. Mitral valve prolapse
E. Osteoporosis

Answer & Explanation

Leaving the Womb

There's nothing like getting an awesome two-for-one deal. In obstetrics they seem to come with every patient visit and with few strings attached - since the majority are using umbilical cords. (My apologies for the bad humor)



Development

Having only been on the OB/GYN service for a couple of weeks now, I am fascinated by the techniques and technology used to evaluate a patient that is barely tangible...the baby. With proper prenatal care, the physician can prepare for the baby's birth well in advance, hopefully avoiding unnecessary surprises on the day of delivery.With each birth, I try to learn something new to be better prepared for the next and acknowledge there is likely no such thing as a routine delivery. Assuming the preparatory work was adequate, the delivery should just be the next step in the process.

As a student I occasionally have a hard time absorbing the hands-on knowledge as I am often listening to my attending's teachings or worse, trying to come up with answers to his questions. After our last delivery, just when I thought I was in the clear and free to synthesize the information I had just experienced, he found more fodder for questioning. "What's this?" he asked as he held up one of the used instruments. Unfamiliar with the tools, I gave each my best guess as he continued to ask the name of everything laying on the sterile field. In a way I feel like I am in the womb of medical school being tested and prodded to make certain there is positive development. With any luck, my "delivery" into the medical profession will be uncomplicated and a day of celebration.

Question of the Week

In discussing Friedman's curve (a plot of obstetric evaluation of cervical progression over time), I was surprised to get a lesson in algebra. After defining the purpose of this graph I was promptly asked, "What is the equation of a line incorporating it's slope?" I was shocked by what my preceptor was asking, and both of us were surprised I remembered it so quickly. How well can you recall it?

Answer & Explanation

A Return to Physical Medicine

My psychiatry rotation was a month of patient or family interviews that provided very little physical examination. The dialogue was our exam. I may have used my stethoscope one time during the entire month and realized at the end how much I really miss medicine.

Mental vs. Physical Medicine

To me, medicine incorporates both the mental problem solving that finds physiological pathology and having physical contact with a patient. This is commonly done as we build our differential diagnosis while performing a physical exam. I feel like a medicinal detective being able to read the various clues from the body to solve an intricate puzzle. Interpreting how a sound, feeling or observation plays into a patient's health is intriguing as well as rewarding.

This month may be a little different. I have started my obstetrics and gynecology rotation. Assuming the patients are comfortable with my participation, I will certainly learn more this month than if I were to wait outside the exam room. Their permission aside, as a male it is difficult to empathize with them, since they experience symptoms that I will never know. Nonetheless, it is a unique specialty including surgery and clinical medicine. It promises to be a fast paced month with plenty of procedures and opportunities to learn. And I can once again use my stethoscope and all the other tools in my pocket.

Of note, both Life as a Medical Student and The Differential (another blog with my contributions) have been featured in this article, "Top 50 Health and Medical Blogs by Graduate Students." Although I don't think there is any meaning to the numbers assigned, it is nice to find blog included among the bunch.


Question of the Week

A 40 year old Caucasian male with a chronic history of paranoid schizophrenia presents to the mental health clinic. He tells you that his wife stole his bottle of risperidone, which he believes caused him to experience more frequent and intense auditory hallucinations. He says the voices tell him to kill his wife because she cannot be trusted. He admits to having homicidal thoughts about his wife but denies any specific plan for harming her. He requests a refill of his risperidone. What is the most appropriate next step?

A. Admit the patient to the psychiatric ward
B. Call the patient’s wife before filling the risperidone prescription
C. Increase his dose of risperidone
D. Refill his prescription of risperidone and call his wife after he leaves
E. Refill his prescription without calling his wife as he does not have a plan to harm her

Answer & Explanation