Category: Medical School

Emergency Medicine, EMS, Medical School

A Simple Way to Include Radiology Imaging in Your Presentation

If you work in the medical field, you’ve likely had to present a patient case report. You do a chart review, gather the physical exam and lab data, but often importing the CT scans, ultrasounds, MRIs and other video imaging for display in your PowerPoint can be a time-consuming and frustrating task.

I recently discovered an easy way to include multimedia medical images into PowerPoint in a fairly easy way. This process works on a Mac. For PCs, I’ve been told Pacstacker  is the best available option for importing radiology imaging into PowerPoint.

You’ll need access to 3 things to get started. Make sure you have each of these available on the same Mac:

  1. The radiology image you want to capture, with the ability to scroll through
  2. QuickTime for Mac
  3. PowerPoint for Mac or PC

QuickTime includes a feature similar to the “Print Screen” feature.  Instead of capturing just one image that instant, it captures your desktop activity in a selected area over time.  The result is a video file you can import into PowerPoint or other presentation software.

Step 1: Open up your Radiology imaging viewer and select the scan you wish to include.

Step 2: Open QuickTime.  From the File menu, select “New Screen Recording.”

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Step 3: When the “Screen Recording” box pops up, click the red circular button to begin.

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Step 4: A tan box will appear, asking you either click once to record the full screen, or drag and select with your mouse the portion of your screen you want included in your screen capture. For capturing radiology images, you’ll want to make sure you include only the image and exclude any personal identifiers to be HIPAA compliant.

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Step 5: While recording, scroll through your imaging study making sure to include everything you want to display.  I recommend scrolling through by clicking the arrows on the keyboard rather than using the mouse, as the cursor may accidentally enter the image field and therefore appear in your presentation.

Step 6: Click  the “Stop” button to stop recording your screen capture.  The button is somewhat hidden in the bar at the top of the screen.  It’s the circular icon with the square in the middle that you see in the image below (right side of the screen, leftmost).

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Step 7: After you click “Stop,” you’ll be prompted to save your video to your computer. Remember the location; you’ll need to find it later when you import your video into PowerPoint.

Step 8: Open your PowerPoint presentation.  To import your imaging study, Go to Insert>Movie>Movie from File.  Then find your file and click OK.

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Step 9: Your imaging study is now imported into PowerPoint as a video.  You can scroll backward and forward as needed during your presentation.  To preview your video, start your presentation and click the triangular “Play” button on the bottom left.  Note: if you click anywhere else on the slide, it will advance to your next slide, not start your video.

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PowerPoint has improved over the years, and videos are now automatically embedded with your presentation when you save your .PPTx file.  You may need to save your presentation file to DropBox, Google Drive or another cloud storage app as the file size is usually too large to send via email.

So that’s it – a previously arduous task made surprisingly simple. I hope this saves you some stress and time.

~Steph

Emergency Medicine, EMS, General, Medical School

5 Things I Learned in Business School I Wish I’d Learned in Medical School

These days, many people enter medicine as a second career.  I am no different.  I was an undergraduate business major and worked in the corporate world of internet marketing for 6 years prior to medical school.  Perhaps a science major would have been more practical when I was spending 7 hours struggling to understand some fundamentals of molecular biology; however, my business background did occasionally give me a leg up. Going back to school at 30-something, surrounded by recent college grads, I realized a few lessons I picked up along the way weren’t necessarily obvious to others.

1. Everyone has a job, and they all matter

Despite modern movements away from it, medicine is an extremely hierarchical world.  Medical students pine for that long white coat.  Doctors bark orders at nurses without introducing themselves or asking nicely.  Phlebotomists, lab techs, housekeepers and others largely go unnoticed.

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Copyright: Michelle Au | theunderweardrawer.blogspot.ca

One beautiful reality of capitalism is that jobs don’t exist unless they are vital… IMPORTANT.  In medicine, we need janitors, doctors, accountants, secretaries.  Everyone with a title has responsibilities and is therefore necessary for the organization to function.  Companies with excess overhead from superfluous staff don’t stay in business very long (VA Hospitals aside). So when the surgical consultant steals a computer terminal from the ED Tech so she can finish her note, this disrupts work flow, and sends a message that somehow the doctor’s work is more important than the ED Tech’s.  It’s just not true.  Be mindful that everyone on the team has a job to do and people will want to be on your team.

2. “For-profit = evil” is not always the case

Yes, pharmaceutical companies are responsible for their reputations as greedy, evil, for-profit companies.  Just ask Martin Shkreli.  And while it would be great to provide free medications to any and all who truly have need, research and development (R&D) of new medications is risky and costs money.  A lot of money.

 

On average, a new drug takes anywhere from 11-14 years to make it to market, and that’s IF the drug makes it that far.  Of any new drug developed in a lab, there is an 8% chance that drug will actually make it to market, meaning it’s prescribed by doctors for actual patients.§ The money spent on R&D for 92% of unsuccessful drugs is a true cost, and those bills still need to be paid.  Smart R&D focuses on modular development, so that one lesson learned developing a drug that failed can be applied to new research that will hopefully help a different drug get to market.

Yes there is excess and greed.  Yes Big Pharma develops drugs based on profitability, not strictly based on need.  People with “orphaned diseases” have to create non-profits and raise funds for R&D since the pharmaceutical companies won’t do it.  It’s not ideal.  Attracting the brightest minds to develop major pharmaceutical innovation requires paying people well, and I’ve yet to hear anyone tout how well-paid they are at their non-profit organization.  In the end, it’s not as simple as saying “just lower the prices or make it free.”

3. Product perception is reality

Marketing is everything.  You can have the best product in the world, but if no one knows it exists, or if consumers don’t understand what it can do for them, they won’t buy it.  Similarly, you can get all the science right in medicine, but if results, diagnoses and plans aren’t communicated, getting it right doesn’t matter.

If anything this is even more applicable in medicine than business.  While people have some innate understanding of what makes a good vacuum cleaner, they probably need more help understanding their liver failure and what treatment they need. I never assume patients understand their disease.  Taking 5 minutes to explain the relation between the liver and ascites goes a long, long way.

4. Dress & Look the Part

Being a medical professional requires knowledge, honesty and altruism.  Most people get that part right.  But professionalism in medicine also means being on time, dressing professionally, and remembering that people are always watching.  So for the EMT: put down the cigarette, tuck in your shirt and wear your gloves when needed.  For the medical student: be the first one arriving to rounds, wash your white coat (not just once a semester either), lose the stubble and open toed shoes and ditch the piercings for the day.  Doctors: wash your hands, put down your iPhone and give patients your undivided attention. All the knowledge in the world can be quickly overshadowed by a distracting or detracting exterior.

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“The Doctor” by Luke Fildes

5. Listen to Customer Feedback

This is not “The customer is always right.” Medicine is different.  Just because a patient thinks he needs antibiotics for his cold doesn’t mean he should get them.  But your customers do know their bodies best and how they are feeling at the time.  If you are handing a patient discharge paperwork and they “still don’t feel right,” stop and listen.  In this case, the customer feedback is critical, and the price to pay may be high – both for the patient and for your wallet.  Any seasoned Paramedic will tell you, “When the patient says they are going to die, I believe them.”  We’ve all been there.  And if you haven’t yet, it’s just a matter of time.

So that’s it, 5 small things.  What lessons have you borrowed from an earlier career and applied to medicine?

~Steph

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§ http://www.fdareview.org/03_drug_development.php

Emergency Medicine, Family & Friends, General, Medical School

Celebrate the Small Stuff: Surviving the Marathon of Medical Training

In just two short months, thousands of newly minted young physicians will be walking into new hospitals, new jobs, and new responsibility. They’ll notice something unfamiliar tickling their calves on that first day – a long white coat having replaced the short one, which in our case went up in flames just days earlier. They’ll be excited and terrified, nervous and naïve.

A doctor’s “intern year” has become something of a legend in pop-culture, portrayed as twelve months of rude awakenings, sleep deprivation and verbal abuse, +/- a love triangle or two. Having been there, done that and proudly owning the t-shirt, I can say the reality couldn’t be further from the truth – at least it doesn’t have to be.*

To all the newbies out there – yes, there will be long hours and sleepless nights. You’ll occasionally go a full week without seeing your loved ones and eat whatever/whenever you can. Med school will seem a lifetime ago when you’re being asked at 3am what to do for a dying person, and you’ll wonder why they never taught you all the things that matter. But Steph and I have stumbled across the solution to all of that.

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Champagne celebration for med school graduation | Photo credit: Amy McClure

We celebrate the small stuff.

Sure we popped champagne like we’d just won a Grand Prix on graduation day, but we’ve also raised a glass to finishing tough rotations, making a clutch diagnosis and running our first double cardiac arrest. We’ve made a ritual of rare Sunday mornings off together with a supply of cinnamon buns always available, just in case. Sometimes we just celebrate because it’s Tuesday and we can. By making a big deal of small victories, the roadblocks become surmountable.

https://www.instagram.com/p/BE2LZoYPaII/

 

Don’t get me wrong – residency is tough. In the past month, three of my patients have died, and I’ve told four others they have cancer. But for every bad day I have had there have been a dozen that left me thinking, “I have the best job in the world.”

I encourage all the newbies out there to approach this next chapter the same way. And remember: when the champagne runs out, there’s always more coffee.

https://www.instagram.com/p/91JrKjPaPL/

 

*Note: does not apply to general surgery residents. Your life will suck.

How do you like to celebrate the small stuff?

~Amir

 

https://www.instagram.com/p/6lCjdKlzlj/

Emergency Medicine, Humor, Medical School

If pages came as emojis

Right now there’s a whole new crop of medical school students graduating in a month who will start their careers as doctors on July 1. There are two things every medical student looks forward to receiving as an Intern – a long white coat and a pager. But any Resident will tell you: after your first night on call, you want to throw that pager against the wall and then stomp it into little pieces.

But what if pages, instead of boring B&W text, arrived as an emoji puzzle to decipher? That just might make getting 84 pages in a 12 hour Trauma shift slightly more tolerable.  See if you can figure out these common pages.

The “Frequent Fliers” of Pages

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Answers to “Frequent Fliers” Pages

  1. Mrs. Jones has a headache, please order tylenol
  2. Mr. Smith has post-op pain, please increase his pain meds
  3. Code Blue, Mr. Jones
  4. Please renew Mr. Smith’s order for restraints
  5. Mrs. Jones needs a diet order
  6. Baby Davis is febrile and has no PRNs
  7. Mr. White needs zofran for nausea
  8. Another ED admit
  9. The transfer from the OSH is on the floor
  10. Please call Pharmacy, you messed up your order again
  11. Who is going home today? -Bed Flow
  12. Mr. Smith needs a laxative
  13. Mr. Jones needs CIWA scoring

And, just for fun, some not some common but ridiculous (and true) pages:

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FYI: 3AM page for a “fever” of 99.0F

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Mr. X had a nightmare. He’s awake now.

Add your own favorite pager stories (and emoji puzzles) in the comments!

~Steph

 

EMS, Medical School, Patient Anecdotes, Virginia Beach

A Neuroscientist’s Look Back on his July 4th Ambulance Ride-Along

On July 4, 2013, Dr. Paul Aravich joined TeamLouka on the ambulance as an observer.  He was asked to jot down a few thoughts on his experience.  His essay is shared below.

~Steph

Reflections of a Virginia Beach Volunteer Rescue Squad Lay Observer, July 4, 2013. 

Paul F. Aravich, PhD
998839_10151588264079545_313081585_nStephanie Krebs and Amir Louka are two VBVRS volunteers and EVMS medical students who are “social change agents and leaders for the greater good of the community.” They invited me to run with them at Station 8 on Independence Day, 2013. I saw 2 other EVMS students that day who I also admire: an exceptional paramedic who is a new medical student, and a Navy veteran and physician assistant student who is as gentle as he is tall. I witnessed great respect between VBVRS, fire department and ED personnel in almost every instance. And I saw cutting-edge wireless technology and state-of-the-art equipment—although I am still not sure if it the ambulance is a box or a truck.

At the station I hung-out with a volunteer from York County who served at the World Trade Centers and Katrina, a new EVMS graduate student, a senior volunteer who is a builder of persons as well as of homes and barbecues, a critical care nurse from Chesapeake, and an accountant. We talked about abandoned older persons, defensive medicine, how to read an ECG, challenging behaviors, not getting T-boned at intersections, altruism, family, political turmoil in Egypt, and who catches a baseball better, the bulked-up waiter at IHOP or a nerd like me who, like Winnie the Pooh, is actually a “bear of little brain.” We also wondered if we heard the dispatcher correctly that a person got stabbed in the cheek with a fork. At one point Stephanie bravely gave me her humerus (which is pretty funny) and Amir gave me his stethoscope and cuff so I could learn the proper way to take a blood pressure. Thankfully, Stephanie’s paresthesia lasted only a few minutes. At the nearby Oceania Fire Station we laughed with an Army veteran who has seen more than his fair share of tragedies, discussed the merits of Cheryl Crow as a History Channel commentator, and had a surprising conversation about the nutritional problems of hot dogs that made me worry that firefighters may someday eschew donuts. I saw camaraderie being built during the down times as well as during the calls. And, I talked with a squad member and former court official about the ones that were saved, the ones that got away, and an aging parent with dementia. I was reminded that all of us have to hold on to our victories, let go of our defeats, and understand that we’re in this together.

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Dr. Aravich & us outside Sentara Virginia Beach General Hospital

Throughout the day I was humbled and inspired by consistent displays of commitment and professionalism, humanism and compassion, and collegiality and mutual support. I saw a successfully aged person with a rare and serious injury that causes significant pain in others but did not in her and wondered if it would steal her independence. I saw an isolated older woman and cancer survivor with depression and abdominal pain and hoped that her GI cancer was not coming back. I saw a frightened young mother fighting addiction and hoped that today will be the first day of the rest of her life. I saw an injured skateboarder who should have known about helmets. I saw a scared older person with breathlessness and fatigue and a family history of heart attack who should not have been cutting grass in the middle of a hot day. I saw the basic life support team immediately recognized the severity of this situation and calmly and effectively take precautions before the paramedic arrived. I saw the paramedic take an ECG in the truck and learned later that it showed the more severe type of heart attack called a STEMI (ST Elevation Myocardial Infarction). I saw the paramedic taking care of this person inside the moving and turning ambulance by, e.g., drawing blood, giving nitroglycerine, sending ECG telemetry to the ED, and offering words of encouragement. Finally, on the 4th of July I saw a crying spouse, caring neighbors, and engaged citizens volunteering to help others when almost everyone else was relaxing.

If, in the Jeffersonian tradition, the pursuit of happiness importantly involves pursuing the greater good, then the VBVRS is full of happy people. And, if people are not distinguished by doing what they have to do but are distinguished by doing what they don’t have to do, the VBVRS is full of very distinguished people. Thank you Stephanie, Amir and the VBVRS for allowing me to see the important volunteer work you do without charging patients. Lives do indeed need saving, both physically and emotionally. All of you saved lives today. Is there any greater compliment? Meantime, a few words about hot dogs: it is OK to bad-mouth hotdogs—but not on the 4th of July.

Dr. Paul Aravich is a behavioral neuroscientist and Professor of Pathology & Anatomy, Internal Medicine, and Physical Medicine and Rehabilitation at Eastern Virginia Medical School (EVMS). He is the former of the Virginia Brain Injury Council and its Ad Hoc Neurobehavioral Committee. He also chaired the Virginia Governor’s Public Guardian & Conservator Advisory Board and sits on the Boards of the Mary Buckley Foundation for brain injury survivors & their families; the I Need a Lighthouse Foundation for suicide awareness; and Alternatives, a nationally recognized youth empowerment organization. He won an AOA Glaser Distinguished Teacher Award. It is the highest award for medical education in the United States and Canada and is presented at the annual meeting of the Association of American Medical Colleges. He also won a Virginia State Council of Higher Education Outstanding Faculty Award, which is Virginia’s highest award for research, teaching and service.
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EVMS Graduation, May 2014
You can view his 2009 TEDTalk here:
To learn more about volunteer opportunities with the Virginia Beach Rescue Squads, visit LivesNeedSaving.com.