The Leeds Medical School Magazine

Christmas 2013
In this issue: - Medic Types - 20 Questions with Pat Harkin - Arterial Blood Gas Interpretation

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Letter From The Editors

Merry Yuletide from Regurg! After a record demand for our freshers edition, were back with a sparkly new xmas issue full of articles to fill your time whilst the rents crack on with the turkey and trimmings. After youve read our cover article on medic types and decided which one you are, compare your tastes with Dr Pat Harkins in our new 20 Questions with.. feature. We do try and retain some seriousness here at Regurg, and this editions educational article takes you through the often confusing concept of acid-base disorders. We hope you all enjoy reading and await our next issue in April next year! /RegurgMagazine @regurgmagazine
regurg_magazine@hotmail.com

In This Issue
4. 5. 9. 12. 15. 18. 20. 21. 23.

Regurg Committee Medic Types An Ethical Dilemma Sicko Film Revieww ABG Interpretation Hopeless Medic: First Aid Medical Mixtape 20 Questions with Dr. Pat. Harkin Homelessness & Christmas

Regurg Committee
Adam Brown | Editor James Gupta | Editor

Alison Hallett | Publicity Rep Steph Harrison | Advertising

Tom Wilson | Publicity Rep

Gracie Collins Abbie Howson

Medic Types

Feature Medic Types Nilo Monfared

As the days grow darker and the inviing smells of pretzels and chai lattes waft over from the German Market, one has time to procrastinate and reflect on their work (or lack of) over the first termand compare with their non-medic mates. As Im sure youve noticed by now, being a medical student is quite a lot different from being a normal university student. Firstly, normal being a crucial term medics tend to be quirky individuals some more than others. Secondly, the term student. When one hears a student on another course describe their contact hours the urge to throttle them with our stethoscopes can be overwhelminghowever, you must resist. Stethoscopes are pricey. As a seemingly separate species to the classic uni student, one might then investigate ( keen RESS-loving scientists as we all are) could we then further classify medics into more genera? The Keen Bean Although we are all to some degree, keen in signing ourselves up for medicine, there are just a few Hermione Grangers that stand out

from the crowd. Staying behind after lectures to ask more questions despite asking numerous during the lecture, always knowing whats happening and having things prepared before even being asked you know them. You might be them. Either way, cheers, good effort, and maybe just save all your questions for after the lectures as some of us like eating lunch. The Stresser in contrast with our well-prepared sprout we have our masters of last-minute. Most people have quite frequent phases of being overwhelmed by the volumes of work, forgetting things then having to rush them, and dealing with random little MANDATO-

RY tasks that pop up on the VLE every now and then (such fun). But a true stresser is someone who consistently has an expression of dismay on their face, perhaps de5

medics tend to be quirky individuals some more than others

velops a nervous tick, or just generally becomes a banter dementor - losing their sense of humour completely as the challenges of med-school seem to drain the joy out of their life. If you know someone like this smile at them every now and again. We all go through rough patches and a friendly face/ Meatfeast from Caf on Campus could really brighten up their day.

They do sleep just not at night. When the clock strikes twelve and the list of distractions is narrowed, a Night Owl comes alive and powers through work they have been avoiding. They can often be heard by their flatmates Skypeing in the dead of night, downing energy drinks in the morning, and sleeping during lectures. But do not fear, these are friendly creatures, and often provide enterThe Night Owl taining Facebook pictures when This is a relatively rare but marvel- their diurnal friends take photos lous sub-species. One might asso- of their new-found narcolepsy.

Feature Medic Types

The student sleeping during lectures may be a stereotype...but that doesnt mean it isnt true!

ciate them with the stressers who feel unsettled by the haphazardness of a medics life and therefore cant sleep a common misconception.

Mr. Medsoc From one noctunal creture to anotherThat guy. Striding down the corridors of Worsley shaking

peoples hands, sharing jokes, kissing babies and what have you he knows EVERYONE. How? He makes it his business to know because he belongs to a brotherhood called Medsoc. Even in Freshers Week, this breed of social butterfly was distributing tickets and coordinating after-parties to parties you didnt even know were occurring. Medsocians have incredible stam-

Feature Medic Types

youve never seen before in your life.and yet there they are standing outside your tutorial room. Although we spend an abnormally long time together as a course, its pretty much impossible to know everyone in your year. Sometimes youll meet someone on exam day who hasnt been to ANY lectures/ tutorials. Sometimes you just think two different but similar people are actually the same personif you are that person dont be offended there are too many of us to get to know as well as wed like to. Maybe consistently turning up to lectures, if not for getting your 9000-worth (or 3000 if youre lucky) is a decent way of making sure people at least recognise your face. What am I doing here? Whether youre a Fresher faced with the Complement Cascade for the first time, or a 4th year preparing for OSCEs, the question does cross our minds at some point. Most medics (if not all but not all like to admit to it) go through a mid-med-crisis. Questioning your decision in choosing medicine is a natural thing. Whether it be because work is piling up, because that last lecturer made you want to scream in frustration, or you
7

ina, managing several consecutive nights in a row and yield cirrhosis-resistant livers that can handle any size bucket. You dont need to look out for this type, they will make themselves known to you. Is she even a medic? Whilst Mr. Medsoc glides among his many comrades and conquests, camouflaged in the cream-coloured concrete of Worsley is a special kind of medic. That guy/girl you swear

simply havent found anything interesting in a while one sometimes does wonder Why the hell did I go through UCAS for this? At times like these it can be reassuring to ask older years for advice before making any rash decisions.

Feature Medic Types

Point is, despite having a large variety of students with different backgrounds, we all have one aim; to make it out of med school in one piece. Learning alongside an interesting mix of people will make the 5/6 years much more enjoyable. Who knows, next time you get into an awkward lift situation A) your fault for not taking the stairs B) take the opportunity to talk to someone you wouldnt usually talk to but you know is on your course you could be striking up a friendship that will last a lifetime.

Its nice hear about the light actually existing at the end of the tunnel. Of course, there are many more types of people who become medics. Some people know that they dont actually want to become a doctor, but have an alternative motive for getting their MBChB. Some DEFINITELY know what theyre going to be, for example Ive overheard oh yes, Im going to be a maxillofacial surgeon (FYI you have to do a dentistry degree as well to go into maxfaxawkward)
8

ant who is going to be signing you off for the next week is askAdam Brown ing you to do something to help your learning. You might not get You are a fourth year student many more opportunities to intuon your ACC (acute and criti- bate patients. But... is the practise cal care) placement. Around two of intubation without the famihours into your first day in A+E, lys consent ethically acceptable? a patient is brought into resus by paramedics. The patient is a 62 Argument for year old male in cardiac arrest. The main argument in support of permitting procedures such as on the newly deceased is the The patients family this benefit to society. It gives physiis waiting outside cians and students the opportunity to practise skills they might unaware not otherwise acquire, provides The paramedics report that CPR an anatomically ideal model and en route has been unsuccessful poses no danger to anyones health. and the patient does not have a It helps to ensure doctors of the shockable cardiac rhythm. Resus- future are equipped and expericitation efforts (CPR, intubation, enced with the necessary skills. drugs) continue until the patients Opponents say that the availabildeath is declared 20 minutes later. ity of mannequins means practice At this point, the emergency med- on the newly deceased person is icine consultant removes the en- unnecessary. However, these mandotracheal tube, turns to you, and nequins are considered to be quite asks you to attempt intubation different to humans anatomically on the now deceased patient. He and are too constant they do not explains that it is normal prac- show variations seen in real people. tice and that it is essential to your Regarding the need for consent, training that you learn to intubate. it has been argued that by virtue The patients family is waiting out- of the patient using emergency side unaware of what is happening. services, they have given implied What do you do? The consult- consent by agreeing to all that

An Ethical Dilemma

Article An Ethical Dilemma

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being in the emergency department entails, including being used for teaching. However, in reality, most patients who die in the emergency department will have been brought in by paramedics in a state of impaired autonomy. Another theory put forward is the idea of construed consent. This says that because we have presumed consent that the patient wishes to be intubated during resuscitation, this consent stretches to being intubated after death. This seems quite far-fetched though, considering the aim of intubation has completely changed.

Article An Ethical Dilemma

strued consent should not count as valid forms of consent for this procedure as the aims of intubation pre- and post-death are so extremely different: one is to save a life, the other is to practice a skill. What should I do if this happens on my placement?

Hopefully none of us should ever be put in a situation like this as doctors should know that carrying out procedures without consent on a deceased patient is illegal. With skills like intubation, although they are far less common than more simple procedures like cannulation, there will still Arguments against be plenty of opportunities to atThe medical professions attention tempt it on your ACC placement. has been drawn to the legal and ethical arguments against using There are also mannequins availathe newly dead for educational ble in the Clinical Practice Centre. purposes. Such arguments clash Never feel obliged to do something with the medical view that dur- unethical because someone higher ing life, the body and personhood up is asking you too. Chances are, if are intertwined but after death the youre gut reaction tells you not to do person is gone and only the body it, then you probably shouldnt do it! remains. Performing intubation without consent on a patient who has just died is likely to be considered repugnant by the majority, as well potentially being illegal if done without proper authorisation. The theories of implied and con11

Sicko Film Review

Review Sicko

Kaat Marynissen

For those who missed Medsins screening of Sicko a few weeks ago, its a film I would definitely recommend you take the time to watch. It is at the least thought-provoking, and definitely topical at a time when issues such as Obamacare can bring an entire government to a standstill. Directed by Michael Moore, Sicko aims to provide an insight into how the American healthcare system affects those (and this is the crucial point) with health insurance. These are the people supposedly protected by the comforting embrace of companies such as Cigna and Wellpoint Inc. An embrace which, remember, would cost the average American a cool $2,196 per year (1).

This fact is something which will come back to haunt you throughout the film; every almost implausibly egregious story is tainted with the knowledge that these victims are the lucky ones, those who managed to work with the system and persuade a company to invest in them and their bodies. Except for when it goes wrong. We hear story after story of those denied treatment, denied basic care even, because something over which they had no control would have lost a company money. Dont get me wrong, Moores documentary is meticulously engineered for maximum emotional impact. Many of the music-laden shots of grateful tears have to be taken with the same pinch of salt one needs when watching the audition rounds of The X-factor. Strip back the melodrama howev-

Denied treatment, denied basic care even

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er, and you are still left with stories care systems around the world, that are absolutely heart-breaking. amongst which is the NHS. In comparison to his homeland the Take for example the 18 month-old principle of free at the point of girl who died after being refused delivery seems utopian, almost the antibiotics that would have comically so. Suddenly we are saved her, all because her mother faced with the realisation that, dewas unable to take her to a hospital spite its systemic failures, its many owned by the insurance company downfalls and imperfections, she was with. Or the 37-year-old the very core idea of the Nationman suffering from kidney can- al Health Service is truly noble. cer, denied a bone marrow trans- Of course, this does not mean plant on the grounds that it was that we should neglect to criticise an experimental treatment. and attempt to improve it. There is much left to be done and many This is when Sicko is at its most subsidiary principles which Im powerful- no narrators com- sure we would do well to revise. mentary and no opinion, just a But please, please lets not lose sight straightforward telling of the facts. of why we are willing to labour It will make you ask yourself ques- and slave over the endless bureautions. Questions such as why cratic details, why we will debate, is it that the 6th richest country campaign, petition and review in the world also has the highest Because at its heart the NHS is a first-day infant death rate out of beautiful thing, and like all beauall the industrialized countries in tiful things it is worth fighting for. the world?(2). Questions such as How can people work within such 1 . http : / / f i nanc e. y a ho o. c om / a system and still feel that they are news/How-Much-Does-Healthfulfilling their duty as doctors? iw-1773357078.html 2.http://www.cbsnews.com/8301Despite this, one thing which this 204_162-57583237/ film will leave you feeling is profoundly grateful. At one stage Moore investigates other health
14

Article Eastern Opportunities

Arterial Blood Gas (ABG) Interpretation

Arterial Blood Gas measurements are something we will all do on a regular basis as a junior doctor and beyond. They are often an important test in a critically ill patient, yet many of us panic when it comes to interpreting the results. The key is to have a step by step, methodological approach to interpreting them which is exactly what this article is going to show you. It is important to remember that there must be a reason for doing an ABG. In other words, dont do one if the results wont change how you manage the patient. Like any test they use up time and money, and in the case of ABGs they are also quite painful for the patient. ABGs provide valuable information about blood pH and the partial pressures of carbon dioxide and oxygen in arterial blood, as well as serum bicarbonate and base excess. Electrolytes, glucose, haemoglobin and lactate are also usually measured. In order to interpret an ABG, we need to know normal reference range values: pH 7.35 7.45 PaCO2 4.7 6.0 kPa PaO2 11.0 13.5 kPa HCO3- Base excess

Article ABG Interpretation

22 28 mmol/L +/- 2 mmol/L then steps:

Adam Brown

Interpretation can be split into 5

1. How is the patient? Always try and see the patient or find out a little bit more about their current condition first as this will provide you with clues to help you with the ABG interpretation. 2.Assess oxygenation Is the patient hypoxaemic? To work this out, it is important to find out if they are receiving any oxygen support. If the patient is breathing air, the PaO2 should be >10 kPa. Otherwise, it should be about 10 kPa less than the % concentration of oxygen they are inspiring. 3.Assess pH Is the patient acidaemic? pH <7.35 Is the patient alkalaemic? pH >7.45 4.Assess the respiratory component If PaCO2 is >6 kPa, this is respiratory acidosis (or respiratory compensation for metabolic alkalosis). If PaCO2 is <4.7 kPa, this is respira15

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tory alkalosis (or respiratory compensation for a metabolic acidosis). If the respiratory disturbance matches the direction of the pH, it is likely to be the primary disturbance. For example, if pH shows an acidaemia and PaCO2 is high, this suggests the primary disturbance is a respiratory acidosis. Remember, carbon dioxide is an acidic gas so if PaCO2 levels are high, the blood becomes more acidic and pH decreases. 5. Assess the metabolic component For this we need to look at bicarbonate HCO3- and base excess. These two values usually mirror each other - if one is raised the other one will be also. If HCO3- is <22 and base excess is less than -2, there is a metabolic acidosis (or renal compensation for respiratory alkalosis). If HCO3- is >26 and base excess is greater than +2, there is a metabolic alkalosis (or renal compensation for a respiratory acidosis.) Again, look to see if the metabolic component tells the same story as the pH. If it does, the metabolic disturbance is the primary disturbance. Now try this example:

Article ABG Interpretation

A 23 year old show jumper is thrown from her horse during practice. On the way to hospital she became increasingly drowsy. The paramedics inserted an oropharyngeal airway and gave her high flow oxygen via a face mask (FiO2 0.4). Her blood gas results are as follows: pH - 7.19 PaCO2 - 10.2 kPa PaO2 - 18.8 kPa HCO3- 23.6 mmol/L Base excess -2.0 mmol/L Using the 5 step approach would go something like this: 1. The Patient - Reduced consciousness level and obstructed airway will cause oxygenation and ventilation to be impaired, likely resulting in a respiratory disturbance. There is unlikely to be any metabolic compensation because the situation is acute. 2. Oxygenation - The PaO2 should be about 10 kPa less than the inspired % concentration of oxygen (which in this case is 40%). Her PaO2 is only 18.8, so oxygenation is impaired. 3. pH - The patient is acidaemic because her pH is less than 7.35. 4. Respiratory component The
17

PaCO2 is above 6 kPa, indicating respiratory acidosis. This is the same end of the spectrum as the blood pH, indicating the respiratory acidosis to be the primary disturbance. 5. Metabolic component Bicarbonate levels are within the normal range, indicating no metabolic disturbance, nor any metabolic compensation for the respiratory disturbance. Summary: Acute respiratory acidosis with impaired oxygenation. Focus would need to be given to this patients airway and ventilation to reduce the PaCO2.

Article Hopeless Medic: First Aid

particularly unsavoury you are probably going to feel a bit like Whhhhyy did I choose this degree?! Here is a cathartic song to help you through. 2) Its my life - Dr. Alban Ok, I know it is a tenuous link but Dr Alban knows best.I swear by this song.pure 90s techno trance therapy. 3) Fever The Muppets When you are called upon to examine a febrile patient, who will invariably sneeze and/or cough in your vicinity.[dont] give me fever 4)The drugs dont work The Verve Kind of depressing, but an awesome song. Its in my head when I see the frequent-attendee IVUDs in A&E: the drugs dont work, they just make you worse, but I know Ill see your face again 5)No scrubs - TLC For when youre scrabbling around the theatre changing room looking for some scrubs that dont fit like Hammer pants or half-mast skinny jeggings.
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Medical Mixtape

Feeling stuck in a rut with your music taste? Why not expand your repertoire with some of these medically related ditties. WARNING: they may now pop up in your head at inappropriate or unexpected times whilst on placement! 1) Bad medicine - Bon Jovi For when youve been asked to take a sample of/examine something

Sarah Dabbs

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6)Dizzy - Vic Reeves and the Wonderstuff Labyrinthitis? Acostic Neuroma? Minires? Benign Paroxysmal Vertigo? 7) The first cut is the deepest P.P Arnold Why not impress your supervising consultant surgeon by singing this as they make that maiden incision? 8)Like a Surgeon Weird Al From the brains behind Amish Paradise (rehash of Gangstas Paradise) and Just too White and Nerdy (comedy cover of Riding Dirty), Like a surgeon is the heartfelt account of a newly qualified surgeon cuttin for the very first time. 9)St James Infirmary Blues Hugh Laurie This is the kind of song that should come with a health warning.its pretty blue.but when House MD is singing about St James Infirmary, its got to make it into the Leeds Medical mixtape! 10) Finals Fantasy The Amateur Transplants As if getting a medical degree isnt difficult enough, these guys have

Article Medical Mixtape

also simultaneously forged a music and comedy career some people are just ridiculously talented. Pretty hilarious lyrics too Is it Pagets? No. Or Badgets? That doesnt exist I thought not. What the hell did you say Badgets for?

20

20 Questions with Dr. Pat Harkin

4. Three fantasy dinner party guests? Fantasy party with real guests or fantasy guests? Ill take the latter: Nanny Ogg from Terry Pratchetts Discworld series (even though the drinks bill might be high), Dr Sheldon Cooper from Big Bang Theory and the Dread Pirate Roberts from The Princess Bride 1. Cats or dogs? Cats. I have three, all Maine Coons. I like dogs, but they require walking, letting it and out, company during the day. Cats are better suited to my lifestyle. 2. The Beatles or The Stones? Neither. They were big when I was growing up, but I was a Bowie/ Queen fan. Not so keen on the later music of either and now I like Barenaked Ladies, They Might Be Giants (both coming to Leeds soon!) and of course my daughters band Sky Larkin. 3. Star sign? Aquaricorn. I have too many personality traits to fit into one sign. 5. Last thing you bought? A coronation chicken baguette from Caf 7. Before that a custom deck of Werewolf cards from the Irish Discworld Convention charity auction. 6. Sweet or savoury? Sweet. I have a horribly sweet tooth. At Xmas dinner, Im just waiting for the trifle. 7. Tea or Coffee? Tea. Theres a reason the coffee cream is always the last chocolate eaten at Xmas. Horrible stuff. 8. Library or nightclub? Library. Anything the Conservatives want to close down gets my vote.
21

Opinion Intercalating Away From Leeds

Opinion Intercalating Away From Leeds

9. All time favourite song? I like a lot of songs Ive only ever sung one song in karaoke so Ill go for that One Week by Barenaked Ladies. 10. Best read? Only one? Tough choice! Fiction Mort by Terry Pratchett. Non-fiction The Code Book by Simon Singh. 11. When you were five, what did you want to be when you grew up? When I was five, I think all I wanted to be was six. 12. Wine or beer? Not an enormous fan of either, though I have recently discovered I like good brandy. And only good brandy! So my answer is wine, I suppose. 13. Sun or snow? I burn really, really easily Celtic background and all that but I do tend to go to sunny places covered in sunblock so effective that if I forget to wash it off Ill get rickets. 14. PC or MAC? PC all the way. Cheaper to buy or build and easier to tinker with.

15. Chinese or Italian? Chinese, but my favourite Italian is Duck in Hoi Sin pizza, the ultimate fusion food. 16. Star Wars or Star Trek? Star Wars. It came out when I was a second year student, so it belongs to my adult life whereas Star Trek is something I watched as a kid. 17. Saver or spender? Spender, Im afraid. 18. Roller coaster or Ferris wheel? Ferris wheel but only because every roller coaster Ive ever been on hasnt been big enough for me to get my legs in comfortably. 19. Medsoc or MSRC? Life member of Medsoc. Never made it onto MSRC. 20. Edward or Jacob? Never read any of the books or seen any of the films but taking as my premise Vampires do not sparkle, Id have to go for the werewolf. Which one is that?

22

Homelessness & Christmas

Article Homelessness & Christmas

of societys burden), were undoubtedly drug addled wastes of time that ought to stop bothering him and making the place look untidy. To that man, I point out the report I caught recently on multiple news channels stating that up to 80,000 children will be homeless this Christmas. I wonder how he could seem to be so oblivious of how this recession brought businesses to their knees and spared few families almost regardless of social and financial standings. It continues to wreak havoc on the lives of many; taking jobs, livelihoods and often even homes as peoples needs increasingly outweigh their means. I shall skim past the schemes of big business owners deliberately neglecting to pass on appropriate shares of the recent upturn. But to return to the point, of course it was not just jobless adults who became homeless, but their children too. I wonder if the man I overheard considers the children at fault for their circumstances too? Growing up below the poverty line (wherever governing powers can manipulate the position of that line
23

Andie Idisi

Stop and think about the man on the street this Christmas- Andie Idisi I suppose I owe this article to the man and his friend who I was at first trapped behind, then too struck to get away from, while heading towards the station. He unknowingly subjected me to a verbal offensive; a strikingly misguided string of complaints about the homeless. According to the learned speaker, those who choose to live in the streets (and he certainly seemed clear on the fact that they do take it upon themselves to adopt the role

Article Homelessness & Christmas

to sit best for them) can create a seemingly insurmountable number of disadvantages. While scores of individuals do make their way out and achieve that coveted social mobility, the idea of those trapped behind being blamed for every aspect of their lives is plainly shameful. Strolling carefree into town he continued to pontificate on the other charmless characteristics of the homeless: under-motivated, uneducated and really why should he give any one of them a penny? His companion took the alternative angle of bestowing pity on the man they had passed, expressing patronising coos in what I often regard as the isnt it sad about Africa? tone of voice. Of course this is preferable to the alternative obnoxious indifference, but it would be somewhat uplifting to think there was another way to respond - one with some genuine human empathy. Individuals do not cease to be human when they become homeless. They do not all acquire a drug addiction overnight (though undoubtedly, for a percentage, sub-

stance misuse will have represented a very significant part of what led to their situation). I hope it would not be impossible for some to consider that there may have been other contributors to the habit and the damage done. Beyond this, I cannot agree that having an addiction automatically disqualifies people from deserving help. There are a lot of malicious and misinformed individuals in the world: if you are looking for people to verbally assault, at the very least, dont make the homeless your target, find something better to do with your Christmas.

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