Monday, January 08, 2007

Interlude




Medical school lecturers are funny (more in a funny frustrating that a funny Ha Ha way). No matter how much time they're given for a lecture, they always want more so they try to cram in twice as much stuff as they can teach well into the lecture slot. Thus, everything gets taught badly. We've just started nephrology and I can tell you, after half a week of whirlwind lectures I'm already starting to feel lost. At least our physiology lectures made sense to me, but we got a lecture today on fluid balance and IV fluids and the woman talked so fast that nobody understood what was going on. Reading over my notes, some contradict what we were previously taught. i.e. her notes say: if you want to give someone salt and water give half-strength saline. I would interpret this as saying that for someone who is hyponatremic give half-strength saline. This is wrong. One should only give hypotonic solutions when someone is hypernatremic because they lower the serum sodium and increase intracellular and extracellular water. If I'm wrong, please, someone correct me.

For a woman who harped on and on about IV fluids being the most important thing to learn from the lecture, she sure didn't treat it like it was. Also, if the information is complete on the slides for many topics, maybe it's more worth spending time on difficult/unclear subjects rather than reading off your 15 pages of slides (6 slides per page).

We also had a lecturer who gave us a sheet of problems to work through in renal physiology and he couldn't do one of his own problems... which makes it doubly difficult for the rest of them to do them!

A tip to medical lecturers: if everyone looks lost, they probably are!

4 comments:

Xavier Emmanuelle said...

You're definitely right about giving hyponatremic patients half strength saline - that makes no sense. That would further imbalance their [Na+] wouldn't it? Anyway, hope your lectures get better!

Jenn said...

Actually, "normal saline" has slightly more osmolality than blood, and remember not all the osmoles in blood are sodium. Giving someone normal saline might be more milliequivalents of sodium than they actually need, depending on the level of their hyponatremia. NS is often used as a frontline resuscitation fluid for dehydration, but when replacing daily water & salt, half normal or even quarter normal is often used.

Second, replacement therapy depends on whether the patient has low sodium with too much water, not enough water, or are euvolemic.

One last thing. Severely hyponatremic patients (125 or lower) may be at risk of central pontine myelinolysis if their sodium is replaced too quickly.

I'm sorry your lecturer did such a poor job of this topic; I can't say that I understand it fully, myself, and I'm a third year.

skinnyminny8 said...

Glad to know med lecturers are crap the world over. Were these mornos never med students themselves?? The ninnies should just let you have notes in advance to read, then spend lecture time going over compex things simply/easily or giving frameworks to help understand and learn things.

I know things are complex and I may not be a bright as these lecturers, but they must go through these topics in their heads, reasoning them out. Why can't they teach it like that?? My lecture today was useless. He spent 45 minutes detailing all the possible causes tests and indications of jaundice. I learnt nothing. He would have been better off discussing just one concept for 45minutes.

L said...

Oh yes...at my school they get a 2 hr slot which somehow becomes a 4 hr slot, they actually think that we can pay attention for THAT LONG??
Oh dear..
Then if we complain they say "this is med school!"
famous last words...*rolls eyes*

love the blog! :)