From July 25th to August 2nd, I was at UC Berkeley for the NSLC Medicine and Healthcare Camp. It was an exhilarating while also an educational experience where I learned so much in such little time with the help of great lecturers and team advisors who helped facilitate this program. I also want to give a special thanks to my entire TA group, who made this experience so much more special. This post is the first part of a two-part series covering the highlights of this camp.
San Francisco General Hospital
We had the pleasure of going to Zuckerberg San Francisco General Hospital for a series of 7 simulations led by various medical professionals. Each was uniquely informative and simulated a real-life scenario, making it all the more valuable; however, I will focus on few of my favorite ones for this segment.
The vital signs include pulse, respiration rate, blood pressure, and body temperature. For pulse, we checked our partner’s pulse along the carotid artery (in the neck) and learned about taking it along the radial artery (in the forearm), brachial artery (front side of the elbow), femoral artery (in the thigh), and popliteal artery (in the knee region). We counted the pulse rate for 15 seconds and then multiplied that number by four to get the beats per minute. A normal heart rate is between 60-90 beats per minute. For respiration rate, we placed our stethoscope above our partner’s lungs to count the rate of breaths per minute, which is supposed to be between 12-20; however, you could also just count the number of times the chest rises and falls in a minute. For blood pressure, we used an automatic sphygmomanometer (blood pressure monitor) and a manual one (along with a stethoscope) in order to measure our partner’s blood pressure. Moreover, we learned that the average healthy blood pressure is usually 120/80, which is written as systolic over diastolic pressure. Lastly, we measured temperature, which can be taken axillary, rectally, and aurally; however, we simply did it orally. The most accurate is rectal temperature (through the core) while the least accurate is axillary temperature (through the armpit). Normal temperature is 37˚C or 98.6˚F.
Starting an IV
Next, we started an IV on a life-sized dummy arm. IVs are generally set up to give fluids, nutrients, or medication to a patient intravenously because it is the quickest way possible. First, you place a tourniquet in the region between where you will be placing the IV and the heart, tying it tight to compress the arm. Next, you use antiseptic to clean the patient’s forearm and insert the IV catheter into the vein at a 30-degree angle. Once you see a flash of blood in the catheter, you withdraw the needle while keeping the angiocath in the vein. Then, you put some saline flush into the vein through the angiocath to clear and clean the IV line. Afterwards, connect the angiocath to the IV connector extension, which goes up the IV bag. Lastly, you put the Tegaderm tape to keep the IV in place.
Intubation is the process of opening an airway for a patient to help them breathe. We did this process for various different dummies. First, you use the manual bag and mask resuscitator to help the patient breathe. Then, you place the laryngoscope in the patient’s mouth and push the tongue to the left to be able to see the vocal cords. You then place the endotracheal (ET) tube through the patient’s mouth until the cuff is past the vocal cords. You subsequently inflate the cuff so that there is friction to prevent the ET tube from getting loose. Lastly, you can attach the ET tube to a manual resuscitator or a ventilator to provide steady air to the patient. It is important to auscultate the lungs afterward to make sure the intubation was done correctly by looking for equal breath sounds on both sides of the lungs.
There was a life-sized dummy that was lying in hospital bed with severe head trauma. The first thing that we noticed was that he had differing pupil dilation, meaning that he had increased brain pressure. This is often deadly because the skull is a closed system with only blood vessels, brain tissue, and spinal fluid, so there is nowhere for the pressure to go. One way to relieve the pressure is a craniotomy (a surgical procedure to get to the brain); however, there is more on that in the next post. We asked the dummy basic questions like “what year is it?,” “what is your name?,” and “where are you?” to check if he had any brain damage, which he did since he did not answer these questions correctly. In addition, we had to log roll him when he started to vomit so that he would not choke on his own vomit. Lastly, we had to provide him with CPR in forms of 30 compressions followed by 2 breaths when he lost his pulse. Thankfully, we were able to stabilize the dummy and move on to the next station.
Stop the Bleeding
One of the most dangerous bleeding is arterial bleeding because it is extremely easy to die from it since the arteries are near the surface on the extremities. Therefore, it is really easy to bleed to death since the bleeding occurs rapidly. The most important thing to do first is to compress the region that is bleeding ideally with fibrinogen gauze that helps blood clot easier. In addition, the gauze or whatever is being used to cover the bleeding should be tied to increase the pressure on the bleeding. If the bleeding does not stop even then, then a tourniquet (if physically possible) should be put to stop the blood flow to that region to stop the bleeding.
Afterwards, we were able to go to one of the most well-respected research facilities in America: the Gladstone Institute. They are doing very interesting work there with stem cells among other things with Dr. Yamanaka winning a Noble Prize in Physiology or Medicine for the discovery of iPS cells (induced pluripotent stem cells). There we had two lectures by researchers doing their post-doctorate at Gladstone about the Zika Virus and Aging.
Dr. Fontaine – Zika Virus
Zika virus is spread by the Aedes aegypti mosquito, and it mostly came into the public eye following an epidemic in Brazil right before the 2016 Rio Olympic Games. While the virus, most of the times, does not give any symptoms in a mother, it does impair the growth of developing fetuses. Babies whose mothers had Zika ended up being diagnosed with microcephalus, which is when they have a small head. This lead to delays in speech/movement along with being mentally retarded and having seizures. Zika virus works by killing the neural stem cells, which eventually become the differentiated neuron and differentiated glial cells in the baby, so this baby does not have these neurons and glial cells. In a healthy person, there is a protein called UPF1 that destroys any improperly copied RNA along with anything that is not the properly copied RNA (for example viruses). However, the Zika virus degrades the UPF1 proteins because a ZIKV capsid binds to UPF1, disrupting the RNA surveillance pathway. This allows the Zika Virus to kill the neural stem cells without being killed itself by the UPF1 protein.
Dr. Bennett – Aging
Biological age is the buildup of damage on a molecular, cellular, and tissue level for 7 distinct reasons: cell loss, division-obsessed cells, death-resistant cells, mitochondrial mutations, intracellular junk, extracellular junk, and extracellular matrix stiffening. Most diseases occur because of some of these reasons. For example, cancer is when tumorous cells divide and undergo metastasis (division-obsessed cells). Heart disease is when there is heart muscle death following a heart attack due to lack of oxygen (cell loss), clogging of arteries (intracellular and extracellular junk), and hardening of these arteries (matrix stiffening). Genetic factors along with other damage (for example cellular metabolism, UV light, and chemical exposure) can also accelerate aging. Eventually, cells reach senescence and stop dividing (often because of telomere shortening). The cells send out a signal, inflaming the region, so that the immune system can get rid of them. However, as Dominick Burton and Valery Krizhanovsky put it, “senescent cells accumulate in tissues, either because an aging immune system fails to remove them, the rate of senescent cell formation is elevated, or both.” The current approach to combat aging is to assess each individual course of the 7 reasons one by one and try to treat the diseases they cause like that. However, in the future, it may be possible to replace, reinforce, and remove parts of the body with regular checkups to elongate life by stopping the damage before it even happens.
Disclaimer: This is solely an educational blog – do not practice any of the medical skills described in this post without proper credentials.
Anisocoria/Pupil Differences. Eye Dolatry, eyedolatryblog.com/2012/02/concussions-and-eye.html. Accessed 4 Aug. 2017.
Burton, Dominick, and Valery Krizhanovsky. “Physiological and Pathological Consequences of Cellular Senescence.” NCBI, ncbi.nlm.nih.gov/pmc/articles/PMC4207941/. Accessed 4 Aug. 2017.
Correct (Endotracheal) Vs. Incorrect (Esophageal) Intubation. Alamy, alamy.com/stock-photo-correct-endotracheal-vs-incorrect-esophageal-intubation-7710490.html. Accessed 4 Aug. 2017.
Measuring Blood Pressure. Aiyus, aiyus.org/category/resource-from-internet/. Accessed 4 Aug. 2017.
Microcephaly. Wikipedia, en.wikipedia.org/wiki/Microcephaly. Accessed 4 Aug. 2017.