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The Daily Rhino
Thursday, July 12, 2007

Try before you prescribe
Originally published in the June issue of Medical Student Newspaper.

How can you ETHICALLY suggest anything for your patient without trying it for yourself? Following a long line of self-experimenting medics, I enlisted some help to make sure I was
doing right by my patients.

IT all started last summer. My good friend Froy (star of the October Rohinplasty) and I had been consuming alcohol whilst watching the blasted World Cup. Soon afterwards we found ourselves re-enacting Streetfighter II on Richmond Green.

Normally I am Ryu and a sure-fire victor. Perhaps it was the Cobra I had been drinking, but I chose Dhalsim this time; Froy was Zangief. One spinning pile-driver later and I was in West Middlesex Hospital demanding morphine for my dislocated and broken thumb.



They appeased me with nitrous oxide. Despite Froy inhaling far more than me, void of any injury that he was, we took it upon ourselves to learn about more of the things doctors prescribe for patients.

By the way, nitrous oxide is truly a wondrous trip. I thoroughly enjoyed my analgesia, even though I had to wear a vomit bowl on my head to stop those goddamn bats getting at my hair.



DIETARY SUPPLEMENTS

We ask for dietitian input frequently at St. Peter’s, chiefly because two of them are hot. Apparently they also supply food things for lazy patients. Lazy? That’s my middle name!



Fortijuice: “A distinctive aroma and a refreshing initial tang. However marred by an iron-y aftertaste, somewhat remeniscent of blood. Goes well with hospital hotpot, but a shameful 150kcal per bottle makes this drink a disappointing 2/5.”



Did you look at Fortijuice and think “looks like some good shit, but I want it as a mousse?” Well damn this is your lucky day. It would be if Forticreme - the gelatinous equivalent of Fortijuice - wasn’t such a revolting pot of quivering horrors. A sad 0/5.



I’m an unshamed fan of Scandishake. Available in the holy trinity of milkshake flavours but the strawberry stands out. A light, tasty whip of calories and vitamins, the fact you have to mix it yourself only adds to the outrageous fun. With a healthy 600kcal per shake, its real plus is it supplies 70% of the suggested saturated fat intake in one easy glass of goodness. An effortless 4/5.




1 spoonful = 1 steak

Calogen is the undisputed gangster in the wild world of dietetics. Reading the nutritional info is enough to strike fear in the hearts of most men, with 250ml packing almost 5000kJ. Upon corking the bottle, one is greeting with a welcome bouquet of strawberry triglycerides. A curious mercury-like surface tension causes it to remain on a spoon when held upside down, but the taste is laced with surprising velvet, supported by a bra of marshmallow. 5/5.



FLUID REPLACEMENT

If you’re anything like me, you’ve spent hours on end wondering what IV fluids actually TASTE like. We took the Rohin & Froy (double) blind taste test. Saline vs dextrose vs gelofusine.



I chose gelofusine. I did this quite deliberately, it was obvious from its darker hue, because I really wanted to drink a COLLOID. Little did I know, I already had - Calogen is a fat emulsion. Somehow I wish I had not gulped the gelofusine with such gusto. I’d imagine this is what man juice tastes like. Remind me to ask the nurses later. Taste: 0/5.

Froy samples an old favourite, normal saline. Although not with any KCl though, that would be weird. “Saltier than a salty sea dog that’s been sailing on a sea of salt in a giant salt shaker with a hull full of salt, who’s just overdosed on salt because he ate some salted peanuts that were salty but not salty enough.” Salt value: 5/5. Taste: 0/5.



PROCEDURES



Cannulation is one of the most common procedures patients undergo in hospital - it is a popular way of getting MRSA. I started with a pathetic blue but then steeled my resolve and chose the green venflon, as not only did it complement my yellow T-shirt nicely, I was attracted to its impressive flow rate of 120ml/min.



Sweet mother of God, I never realised how much this hurt. Maybe due to the fact I was cannulating myself, but something made this excruciatingly painful.

However the pain was relieved by a sensation I recommend to anyone - a big flush of refridgerated normal saline. If I took heroin, I’d definitely put it in the fridge.
If. Pain rating: 3/5.



BM testing. This is so painless I can’t even be bothered to write about it. It’s lame, I don’t get why people do this. Who wants to know their blood sugar? Boring! Pain rating: 0/5.



People always seem to moan about ABGs over venflons. As far as I can tell, it’s the other way round. I enjoyed seeing my arterial blood fountain out into a syringe. I quite fancy an angiogram now. Radial approach, wooo! Pain rating: 2/5.



THINGS WE MIGHT HAVE TRIED. MIGHT MIGHT MIGHT.



Morphine is a powerful and dangerous opioid analgesic and sedative. It can cause respiratory depression, itching, and constipation. Froy and I are off to spend the rest of the afternoon lying in the sun watching cricket.

The legal bit: So that the editor of Medical Student Newspaper or any Daily Rhino-reader does not perform any further painful procedures on me, neither I nor Medical Student Newspaper advocate taking any of the products mentioned in this article unless prescribed by a medical professional. All products utilised were expired or unsuitable for patient use.

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Use a 27 (or 29G if you can get them, or 25G if that is the smallest you can find - as in the Radial artery picture) to raise a tiny (0.1 ml is at least enough) bump with local anaesthetic (use 2% Lidocaine) in the skin where you are going to put the cannula. You can go a little down the proposed track, but don't actually puncture the vein with it although if you did, it probably wouldn't bruise.

Then it doesn't hurt, much.

If someone says the size of the needle doesn't affect the pain (and they keep on saying this, I don't know why) then hand them a 29G needle, and, picking up a 14G brown venflon (unless you can find a 12G) propose the obvious trial.
 
great blog, very informative!!!

rhino nitrous
 
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