Transcript: David Ray Ms. Rosenbaum AP English Language and Composition- 1A September 16, 2011 Never Would Have Guessed It When I was younger, speaking in front of people was a big deal to me. Back then, I found it very difficult to stand in front of a large group of people. I am sure that we all remember our grade school years, when we had to do the Tropicana Speech; it was undoubtedly difficult for all of us. I distinctly remember doing my speech in front of the school and messing up: badly, very badly. It didn’t end up bothering me too much though, as I ended up taking 2nd place in the competition anyways. If anything, the experience helped me get over my problem. Regardless, it is easy to see that today I have long overcome my troubles with speaking in front of others and that it is no longer a big deal to me. The Most Comfortable Pants in the World On Christmas of last year, I, along with Andrew Baldridge, surprised Talon with a gift that he definitely did not expect. Around this time, my friends and I had arranged a "white elephant" of sorts, without the element of surprise. Nobody could decide what to get for Talon, so together Andrew and I developed an ingenious idea that would soon become what is basically the greatest gift of all time. We bought a pair of cheap jeans (very, very, cheap) and a pillow, which (in reference to joke) we sowed onto the inside of the jeans, in order to give the wearer of the pants the most comfortable butt in the world. To top it off, we wrote "Most Comfortable" on the back of the pants for good measure. Needless to say, this gift was very funny for everybody, and comfortable. The only thing that could have made this story better is if we had used memory foam rather than a pillow on the pants. What Were We Mad About Again? I have been close friends with Talon Bullard for many years. Like we all know, when friends are together for a long time, they will quickly forgive and forget any arguments they may have had in the past, emphasis on forget. Several years ago (probably in 2005 or 2006) Talon and I went on a summer trip together. During this trip, Talon had gotten sick to the point where he had lost his voice completely; he had to whisper everything or his words would be inaudible. At some point during the trip, for reasons beyond me, we had gotten into an argument. The same day, we went canoeing together: bad idea. I sat in the front of the canoe and, naturally, Talon sat in the back. Throughout the duration of the trip, I was constantly turning around and yelling something stupid that a ten year old kid would say (as I was ten years old, probably), and Talon would immediately attempt to yell something back, but his voice would instead simply trail off into silence. It is amazing that we never tipped the canoe over. Years later, we are still very close friends who look back and laugh about just how foolish we once were. For the life of me, I still cannot remember what we had fought about. Trust Me, it is This Way A few years back, I had once gone on an orienteering course in the woods with a group of people I knew. The basic idea behind the course was for us to use a compass and count paces (for distance) to find our way from point A to B, and so on. I distinctly remember determining which way to go, when one of the other members told us the way he thought was correct, a way very much different from mine. However, I decided to follow his path, as I had cared far too much about his opinion. We did not finish the course for hours. Never Knew I Changed When I was very young, I grew up as a rather shy child. I grew up with my neighbor, whom I consider to be my older brother. After spending many years with this person, I ended up being the outgoing person I am today. I had never noticed this change occurring while it was happening, but I know that much of it was due to him. Hilarious One Year Later Vignettes Ugh...
Transcript: Symptoms: A rotator cuff tear is a common cause of pain and disability among adults in the US. Past History: History of present illness: CLINICAL VIGNETTE... Shoulder Tear rotator cuff Abduction A 70 year old female returns today for re-evaluation of her R and L shoulder. Her R shoulder is improving with phsical therapy. She does have some pain anteriorly. Her L shoulder is continuing to cause her severe discomfort and pain at night time primarily. Now, she has difficulty reaching, grasping, pulling, and pushing to the L shoulder. Her pain is worsend and at this time she would like to proceed with L shoulder surgery. Treatment Plan: 140 degrees 70 degrees 40 degrees 90 degrees Findings: Shoulder Motion is Restricted THANK YOU!!! There are different types of tears. Partial Tear. This type of tear damages the soft tissue, but does not completely sever it. Full-Thickness Tear. This type of tear is also called a complete tear. It splits the soft tissue into two pieces. In many cases, tendons tear off where they attach to the head of the humerus. With a full-thickness tear, there is basically a hole in the tendon. 90 degrees Right Left Normal Take home points: Laboratory Findings: History of present illness: Name: Caradaga, Adelaide DOB: April 26, 1968 DOI: June 26, 2014 Claim Number: 000690-006258-WC-01 History of present illness: 70 degrees 40 degrees 90 degrees ICD codes: 726.13 (L Partial Tear Rotatr Cuff) 726.2 (L Shoulder Region DIS NEC) External Rotation The most common symptoms of a rotator cuff tear include: Pain at rest and at night, particularly if lying on the affected shoulder Pain when lifting and lowering your arm or with specific movements Weakness when lifting or rotating your arm Crepitus or crackling sensation when moving your shoulder in certain positions Laboratory Findings: 180 degrees • The minimal invasiveness of the procedure will allow for quicker healing when compared to more serious surgeries. • Arthroscopy allows for less scarring and scar tissue so that you will have better movement in your arm and shoulder. • You will be able to regain more use from your arm and shoulder when compared to living with the damage or inflammation that was hindering it. • Arthroscopic procedures cause minimal blood loss. This allows for less bruising and pain during recovery. Acute Tear If you fall down on your outstretched arm or lift something too heavy with a jerking motion, you can tear your rotator cuff. This type of tear can occur with other shoulder injuries, such as a broken collarbone or dislocated shoulder. There are definite benefits to choosing shoulder arthroscopy. Not only will you gain the benefits of a repaired shoulder, but also the arthroscopic procedure itself is much more beneficial than choosing standard types of invasive surgeries. Statistics/Evidence based practice: Let's start!!!! Arthroscopy remains the safest form of surgery in treatment of shoulder tear rotator cuff Several factors contribute to degenerative, or chronic, rotator cuff tears. Repetitive stress. Repeating the same shoulder motions again and again can stress your rotator cuff muscles and tendons. Baseball, tennis, rowing, and weightlifting are examples of sports activities that can put you at risk for overuse tears. Many jobs and routine chores can cause overuse tears, as well. Lack of blood supply. As we get older, the blood supply in our rotator cuff tendons lessens. Without a good blood supply, the body's natural ability to repair tendon damage is impaired. This can ultimately lead to a tendon tear. Bone spurs. As we age, bone spurs (bone overgrowth) often develop on the underside of the acromion bone. When we lift our arms, the spurs rub on the rotator cuff tendon. This condition is called shoulder impingement, and over time will weaken the tendon and make it more likely to tear. 140 degrees 90 degrees 180 degrees ICD/CPT Codes: Past History: Case Study: Demographics Causes: CPT code: 29826 (L shoulder Arthroscopy with Subacromial decompression) Continue physical therapy for the R shoulder Home exercise program Candidate for L shoulder arthroscopy with subacromial decompression and debridement Requesting an Ultrasling, physical therapy 12 sessions post operatively and assistant surgical assist for the L shoulder A rotator cuff tear is a common cause of pain and disability among adults. In 2008, close to 2 million people in the United States went to their doctors because of a rotator cuff problem. A torn rotator cuff will weaken your shoulder. This means that many daily activities, like combing your hair or getting dressed, may become painful and difficult to do. Flexion Degenerative Tear Most tears are the result of a wearing down of the tendon that occurs slowly over time. This degeneration naturally occurs as we age. Rotator cuff tears are more common in the dominant arm. If you have a degenerative tear in one shoulder, there is a greater risk for a rotator cuff tear in the opposite shoulder -- even if you
Transcript: Chapter Vignettes Group 4 Summary Born Bad -Esperanza and her friends, Lucy and Rachel, start mocking famous people. The game then turns into mocking her Aunt Lupe, who is blind. Her aunt then dies that day and she is ashamed. She then says that her Aunt made an impact on her because she always listened and encouraged her to keep writing. Characters Characters Esperanza: main character Lucy and Rachel: childhood best friends Aunt Lupe: blind aunt Conflicts Conflicts Man vs Self: "Most likely I will go to hell and most likely I deserve to be there." pg. 58 In Born Bad (italics), Esperanza learns to treat everyone with respect. Theme Theme Throughout the Vignette, Esperanza realizes she should not mock other people, especially the one's she loves. "And then we began to dream the dreams." Pg. 61 Coming of Age Coming of Age Summary Four Skinny Trees She is looking outside the window with her sister at four skinny trees and realizes the beauty surrounding her Esperanza: main character Nenny: Esperanza's sister Characters Characters Man vs Self "When i am too sad and too skinny to keep keeping, when i am a tiny thing against so many bricks, then it is I look at trees" pg. 75 -Even though she might struggle, she should still keep going with her life Conflicts Conflicts In Four Skinny Trees (Italics), Esperanza learns to look for the beauty in life. Theme Theme She learns to continue on in life when something gets in her way. "Four whose only reason is to be and be" pg. 75 Coming of Age Coming of age
Transcript: Mr. HH is a 55 year old disabled, single, Caucasian male who presents with: 5 day history shortness of breath dizziness non-productive cough CYP3A4 CYP2E1 D-dimer - 2.06 Normal WBC - 13.9 At discharge: Bridged on enoxaparin Warfarin Stop EtOH use Follow-up with anti-coagulation clinic EtOH Troponin x 1 - negative Feb 2008 - 1st UIHC ETC visit intoxication chest pain dyspnea Past medical history: Coronary artery disease with stent placement 2010 COPD Alcohol dependence Hepatitis C Increased Anticoagulation April 2010 unstable angina bare metal stent placed RCA "I don't plan on drinking any longer." Over the next 2 weeks, readmitted x 2 with: depressed mood poor sleep poor concentration rumination of his PE intense fear that he would die from PE or "bleed to death" prominent active suicidal ideation suicide attempt by overdose alcohol intoxcation 2012 Discussion By: Andrea Ryan Mentor: Vicki Kijewski Feb 2008 - April 2010 10 ETC visits for: chest pain and/or dyspnea intoxication 5 ETC visits for: anxiety and/or depression suicidal or homicidal ideation INR 6-8 at admission Restarted and discharged on warfarin Drug (ie warfarin, argatroban, rivaroxaban) Past psychiatric history: Diagnosed depression age 17 after brother's death 1 suicide attempt by cutting (meth intoxication) Multiple hospitalizations Unreliable with follow-up Significant Imaging Studies Thank you! Vicki Kijewski Ravneet Dhaliwal Overall, anti-coagulation treatment must be individualized based on risks and benefits of therapy. Ability to maintain safety Reliable outpatient monitoring Other medical co-morbidities Psychosocial stressors Risk and severity of possible depressive episode Drug Moderate consumption Significant Laboratory Studies Chronic alcoholic 2008 Cardiac: Elevated rate Regular rhythm No rubs, murmurs, S3/S4 1. Depression has been shown to significantly increase morbidity and mortality in patients admitted with acute life-threatening illnesses, such as PE. CT Angiography: "There is evidence of scattered pulmonary emboli in the left lower lobe. No evidence of pulmonary thromboembolic disease in the right lung. No right ventricular strain." Anticoagulation 4. Many short depression questionnaires are accessible for discharge evaluation and may reduce discharge medical complications and readmissions. Vitals: HR 130 RR 14 BP 137/99 Not orthostatic SpO2 88% on RA 3. In studies of depressed cardiac patients, improvement in depression was associated with improved self-reported adherence to medications and lifestyle modifications. "I would rather kill myself..." Decreased Anticoagulation Drug EtOH Increased Anticoagulation Arterial blood gas (on 2L): pH 7.42 pCO2 40 HCO3 26 pO2 95 April 2010 - Nov 2012 10+ ETC visits for: chest pain and/or dyspnea intoxication 6+ ETC visits for: anxiety and/or depression suicidal or homicidal ideation November 6, 2012 dyspea lightheaded diagnosed with pulmonary emboli Nov 15 and 20, 2012: intoxication depressed mood poor sleep poor concentration rumination over PE suicidal ideation with attempt 2. Rumination was an independent predictor for the incidence and severity of depression 3 months after acute coronary syndrome (ACS), regardless of baseline depression scores or cardiovascular disease severity. Social history: Navy, dishonorable discharge Currently disabled Iowa Lodge, alone EtOH and IV drug use history 2010 Lungs: Increased effort of breathing Distant lung sounds Clear to auscultation No wheezing Drug Physical Exam 5. Oral anti-coagulation treatment in the context of alcohol dependence is a high risk factor for hemorrhagic complications. References Bauer et al. Effects of Depression and Anxiety Improvement on Adherence to Medication and Health Behaviors in Recently Hospitalized Cardiac Patients. Am J Cardiol 2012;109:1266 –1271. Denton, E.D. et al. Psychosocial vulnerabilities to depression after acute coronary syndrome: the pivotal role of rumination in predicting and maintaining depression. Frontiers in Psychology 2012; 289:1-9. Donze, J. et al. Risk of Falls and Major Bleeds in Patients on Oral Anticoagulation Therapy. The American Journal of Medicine 2012; 125: 773-778. Miller, C.S. et al. Meta-Analysis of Efficacy and Safety of New Oral Anticoagulants (Dabigatran, Rivaroxaban, Apixaban) Versus Warfarin in Patients With Atrial Fibrillation. Am J Cardiol 2012;110:453– 460. Prandoni, P. Anticoagulant treatment of pulmonary embolism: impact and implications of the EINSTEIN PE study. European Journal of Haematology 2012; 89:281-287. Silverstone, P.H. Depression Increases Mortality and Morbidity in Acute Life-Threatening Medical Illness. Journal of Psychosomatic Research 1990; 34:651- 657. Weathermon, R; Crabb, D. Alcohol and Medications Interactions. Alcohol Research and Health 1999; 23:40-54.
Transcript: Age: 8 years old Gender: Male Ethnicity: Latino (Salvadorian) Religion: Catholic Leo attends a predominately African-American school in South Los Angeles. Leo's family is very supportive Leo tends to gravitate towards his siblings even while at school He has stopped interacting with students verbally What's my Diagnosis? Leonidas Garcia [Leo] When Symptoms Started: Stutter since speech began, his refusal to speak to others outside of immediate family is 3 months. What happened: Father was deported in December of 2016 since then his grades have dropped significantly. What changed: Students in his class have teased him over his accent and stutter. Trump's presidency and deportation raids of Latino undocumented. Presenting Symptoms Referral Client Symptom(s): (a)Stutters (b) absent speech to others outside of immediate family Onset: (a) since he began speaking (b) January 2017 [3 months] Frequency: (a) most noticeable when anxious or nervous (b) everyday at school and other settings outside of home Family Systems/Living Situation Who: 3rd Grade Teacher Why: Unable to participate in school activities and decrease in his interaction with peers Who: lives with mother, maternal grandparents, older sister and younger brother. *He is the middle child * Closest to his mother, and grandparents *Was close to father * Siblings are very protective of him Education/ Friends & Support System History Clinical Case Vignette
Transcript: huddle Mrs. Rossi huddle to crowd together crowd huddle separate
Transcript: 1480 Time: 1515- 1547 Location: France 1300 1500 Artist: Leonardo Da Vinci Created Through: 1503-1517 Created: 1300 Located: Described: Explained: horizontal bar with weights on its ends. It sits on a rod, called "verge." The verge has pallets to start and release the main gear that is turned by a heavy stone on the end of a cable. Birth of Leonardo da Vinci. Artist: Leonardo Da Vinci Created Through: 1445-1498 1503: Pope Julius II appointed Pope; start of “Roman Golden Age”. 1547 Timeline Power Point 1300 Invention of the first mechanical clock. Artist: Leonardo Da Vinci Created Through: 1483- 1486 Virgin of the Rocks Mona Lisa Born: April 15, 1452 Location: Vinci Italy The Last Supper Location: Roman Golden Age, Rome 1515: Francis I takes power in France. 1440
Transcript: Clinical Assessment Alyssa Villa / UHV 5/2/20 Diagnosis Diagnosis George a 16-year-old male The Case of George The Case that I chose was about George, a 16-year-old male that has had multiple suicide attempts and substance use. He has used multiple substances (marijuana, LSD, etc) since 13. Ct has also had a 2 week history of depression and ended up in the hospital due to a suicide attempt while in a Juvenile detention center. He has had problems with his parents and principal. The Case of George Diagnosis After reading that Ct has used drugs since the age of 13 there are multiple drugs he has used during this time. When he is not using drugs, he is more productive. During the substance use he has attempted suicide, been in arguments and has been put in a juvenile detention center. He was put in a youth home, away from his parents. I have chosen the diagnosis of Substance Abuse Disorder after reading the DSM-5. Diagnosis Diagnostic Criteria Diagnosing George with Substance Abuse Disorder Diagnostic Criteria Deciding on Dx Deciding on the Dx Emotional/ Negative effects of substances. Depression Mood Changes Decreased appetite Decreased interest Suicidal thoughts Feelings of guilt Continued use of substance after consequences Using marijuana, LSD, non-opioid sedatives. Ruling out other Dx Ruling out other Dx Regarding other diagnosis, I was torn between a few. I believed that he displayed symptoms of depressive disorder. I also looked into Substance induced bipolar disorder. I felt that looking at the symptoms and the behavior he displayed, it made more of a connection to the Substance Abuse Disorder. I looked at the symptoms and felt that they established a connection to Sub Abuse. Specific Signs Beginning drugs at the age of 13 The signs of depression while using the substance. Behavior resulting in negative consequences while using the substance. Poor school behavior Lack of interest Withdrawn Specific Signs Children Vs. Adults Differences between Children & Adults Diagnosis verses adults Difference Difference There is a higher prevalence in drug use in the ages of 18-24, George is close to this age group. Marijuana, I saw a higher prevalence for male individuals that are from ages 12-17 With the adolescent range that George is in, he shows changes in his mood, energy and eating patterns that were listed in the DSM-5. Difference Cont'd . There are also social and school indiscretions that were noted as well. George shows behavior that relates more to the adolescent age group. Difference Continued Diagnostic Specifiers Diagnostic Specifier Additional symptoms Additional Specifiers Specifiers How long he went without the arguments with family or others Any signifier as to why he argues with his parents More about the length of his depression and the moods that he experiences What leads to the use of a substance. Any relation to suicidal thoughts
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