my dad likes to remind me that when he trained in internal medicine in the late 1960's and early 70's, they were still applying rotating tourniquets to patient's extremities in an effort to manage the volume overload of decompensated congestive heart failure, the idea being that, by temporarily pooling venous blood in the extremities, the failing heart would be better able to handle its load. once the potent diuretic lasix made its debute, the tourniquets fell by the wayside.
sometimes i wonder, what will be my rotating tourniquets? what am i doing right now that i'll eventually look back and say, wow, can you believe that's the best we could do to manage that problem? i think about the mask and machinery of CPAP (continuous positive airway pressure used to treat obstructive sleep apnea). the patient is tethered each night by a tube to a machine that blows air into his or her mouth to prevent airway collapse. the effect is akin to a slumbering darth vader. it is a far cry from the tracheostomy that used to be employed (only in the most extreme cases) to prevent this problem of arrested nocturnal respiration and its ultimate strain on the heart, but still a far cry, too, from ideal. what better interventions will come? i wait for them eagerly.
Since you are determined to make me an old fart...
ReplyDeletehow about a sippy diet for peptic ulcer disease, or 1-2 weeks of absolute bed rest with pelvic traction for back pain. All of this in the hospital!
What are the top 20 reasons patients see you in your office? I am a FM PGY1 in Oklahoma and I'm comparing NP:FM:IM and patient cases to see if there is a difference.
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