Savouring the quiet moments 🌱
With your healthcare, do you also not pay for prescriptions? What types of things aren’t covered, if anything?
Most people (including me) do pay for their prescriptions in England, but there are certain circumstances where you’re entitled to get them for free, e.g. if you’re over 60 or under 20, on income support, pregnant, or have a long-term physical disability.
To add to this, anyone can get the contraceptive pill for free.
Also, minor correction - prescriptions are free when you are younger than 16, and when you’re 16-18 in full time education.
I don’t know what student needs to hear this right now but there is no superiority in being constantly stressed out. if you find yourself competing with classmates to see who has the most work or studying to do or who got the least amount of sleep last night, please, please stop. I promise you it’s so much better for your long term health to not engage in those kinds of toxic interactions. get enough sleep, eat enough food, and stay away from people who derive their self worth from how much work they have to do
Especially in medicine I feel like competitiveness is a real issue. You have to learn how to focus on yourself and your progress, and not stress about what other people may or may not have done. And when you find people that are obsessed with comparing themselves to others, keep your distance, because that can be infectious.
It’s so important to have a balance in life, which you shouldn’t sacrifice because ‘xyz would be studying right now so I should too’. Look out for yourself & focus on your own happiness 💖
DRSABCD is a familiar acronym for those who have undertaken First Aid/Basic Life Support courses. Now DRSABCDE can used as a simple, yet comprehensive, approach to CXR interpretation.
D – Details:
- Patient name, age / DOB, sex
- Type of film – PA or AP, erect or supine, correct L/R marker, inspiratory/expiratory series
- Date and time of study
R – RIPE (assessing the image quality)
- Rotation – medial clavicle ends equidistant from spinous process
- Inspiration – 5-6 anterior ribs in MCL or 8-10 posterior ribs above diaphragm, poor inspiration?, hyperexpanded?
- Picture – straight vs oblique, entire lung fields, scapulae outside lung fields, angulation (ie ’tilt’ in vertical plane)
- Exposure (Penetration) – IV disc spaces, spinous processes to ~T4, L) hemidiaphragm visible through cardiac shadow.
S – Soft tissues and bones (it is common to leave it until the end)
- Ribs, sternum, spine, clavicles – symmetry, fractures, dislocations, lytic lesions, density
- Soft tissues – looking for symmetry, swelling, loss of tissue planes, subcutaneous air, masses
- Breast shadows
- Calcification – great vessels, carotids
A – Airway & mediastinum
- Trachea – central or slightly to right lung as crosses aortic arch
- Paratracheal/mediastinal masses or adenopathy
- Carina & RMB/LMB
- Mediastinal width <8cm on PA film
- Aortic knob
- Hilum – T6-7 IV disc level, left hilum is usually higher (2cm) and squarer than the V-shaped right hilum.
- Check vessels, calcification.
B – Breathing
- Lung fields
- Pleura: reflections, thickenning
- Vascularity – to ~2cm of pleural surface (~3cm in apices), vessels in bases > apices
- Pneumothorax – don’t forget apices
- Lung field outlines – abnormal opacity/lucency, atelectasis, collapse, consolidation, bullae
- Horizontal fissure on Right Lung
- Pulmonary infiltrates – interstitial vs alveolar pattern
- Coin lesions
- Cavitary lesions
C – Circulation
- Heart position –⅔ to left, ⅓ to right
- Heart size – measure cardiothoracic ratio on PA film (normal <0.5)
- Heart borders – R) border is R) atrium, L) border is L) ventricle & atrium
- Heart shape
- Aortic stripe
D – Diaphragm
- Hemidiaphragm levels – Right Lung higher than Left Lung (~2.5cm / 1 intercostal space)
- Diaphragm shape/contour
- Cardiophrenic and costophrenic angles – clear and sharp
- Gastric bubble / colonic air
- Subdiaphragmatic air (pneumoperitoneum)
E – Extras
- CVP line, NG tube, PA catheters, ECG electrodes, etc
My morning has been spent writing up notes and completing online assessments for a job application. I plan to finish up on some work sheets this afternoon before heading to the gym!
Also, say hello to my plants: Chandler, Joey and Yimika! (Yimika is in my CERN mug which used to be functional as a mug before it broke and had to be put back together with superglue)