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TSR Med Students' Society Part III

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So a guy I knew died of a PE a few weeks back but I only just found out about it. I didn't know him very well but he died at the tender age of 27 and was a very intelligent well spoken guy so it was a real shame.

After the initial "that sucks" phase yesterday I'm not filled with the morbid curiosity of the medical student on how exactly you can die of a pulmonary embolism. He used to be quite a large guy and then lost quite a bit of weight. He never really did any exercise and was ill for about a week before so I understand he had quite a few risk factors for a clot to occur somewhere.

However, the clot moves to the lungs and increases the pressure in the pulmonary arteries (presumably it gets stuck before it reaches the veins by getting jammed in the small arteries) and would diminish lung function but I don't see how that would kill you? People can live with one lung so I can't see how having a small section being messed up causing you to become hypoxic enough to kill you.

So, does the build up of pressure cause the right ventricle to swell and fail? Would this then possibly tear/burst? Could the same happen to the great veins? The online articles on emedicine/wiki are pretty sketchy and vague so any help would be appreciated.
Original post by RollerBall
So a guy I knew died of a PE a few weeks back but I only just found out about it. I didn't know him very well but he died at the tender age of 27 and was a very intelligent well spoken guy so it was a real shame.

After the initial "that sucks" phase yesterday I'm not filled with the morbid curiosity of the medical student on how exactly you can die of a pulmonary embolism. He used to be quite a large guy and then lost quite a bit of weight. He never really did any exercise and was ill for about a week before so I understand he had quite a few risk factors for a clot to occur somewhere.

However, the clot moves to the lungs and increases the pressure in the pulmonary arteries (presumably it gets stuck before it reaches the veins by getting jammed in the small arteries) and would diminish lung function but I don't see how that would kill you? People can live with one lung so I can't see how having a small section being messed up causing you to become hypoxic enough to kill you.

So, does the build up of pressure cause the right ventricle to swell and fail? Would this then possibly tear/burst? Could the same happen to the great veins? The online articles on emedicine/wiki are pretty sketchy and vague so any help would be appreciated.


Really sorry to hear that :frown: I feel for his family, especially with Christmas coming.

Interesting theories - but perhaps the mechanism isn't the V/Q mismatch but more to with obstructing circulation therefore resulting in obstructive shock - circulatory failure?

One paper I've found:http://www.ncbi.nlm.nih.gov/pubmed/13107427 (cannot access)

Another: http://www.ajronline.org/content/174/6/1489.full

This one states:

'...First, the mechanism of death from pulmonary embolism is not as straightforward as simple mechanical obstruction; other causes such as reflex and humoral mechanisms have also been implicated...'

Another source says:

Large emboli cause sudden death by:

(a) lodging in major branches of pulmonary arteries or at bifurcations, causing electromechanical dissociation with rhythm but no pulse or

(b) acute cor pulmonale (dilation of right side of heart) due to local increased resistance to blood flow, pulmonary hypertension and right sided failure

From: http://www.pathologyoutlines.com/topic/lungnontumorinfarct.html (might actually bookmark this as it has all the important stuff bullet-pointed).


Hmm I'm starting to miss Medicine.
(edited 12 years ago)
Original post by Supermassive_muse_fan

Original post by Supermassive_muse_fan
I still have a book from semester 3. Semester 3 was 1.5 years ago. :s-smilie: I don't even want to ask how much I owe :redface:


See we're not allowed to register for the returning year until all debts have been paid off, so we could be overdue for a year at max. I'm yet to have any late fees :proud:
I literally <3 having my xbox back.
Original post by RollerBall

Spoiler


Sorry to hear about that. Grim stuff.

As for an explanation:
It'll depend a lot on the type of PE itself.

Massive PEs are pretty obvious. You block off a load of the pulmonary circulation so there's little returning to the left side of the heart, leading to dramatically decreased cardiac output. Then you get reduced end organ perfusion and less blood running through the coronaries. Things are pretty straightforward with these types.

Gets a bit murkier with the smaller ones. My understanding (which could be inaccurate; point out the inaccuracies!) is this:
The very distal aspects of the respiratory tract are generally supplied with oxygenated blood by the pulmonary circulation (the bronchial circulation doesn't reach as distal as the alveoli). Over time you end up with necrosis of the surfactant-producing pneumocytes and general infarction of the alveoli etc., leading to alveolar collapse (= frank hypoxia and impaired oxygenation of end organs) and backing up of blood up the pulmonary circulation, leading to an acute pulmonary hypertension (potentially with subsequent oedema) and, over time, cor pulmonale.

Point probably worth noting is that if you get one small one, your odds of becoming ill aren't necessarily that high. You'll generally just redistribute blood away from the clot site, lyse it and clear it out. You'll get sick if you get a number of smaller ones.
(edited 12 years ago)
Original post by gozatron
We get charged 50p an hour overdue for short term loan books. :ninja:



Original post by xXxBaby-BooxXx
See we're not allowed to register for the returning year until all debts have been paid off, so we could be overdue for a year at max. I'm yet to have any late fees :proud:


We have no charges for late books :ahee:

Now how to motivate myself to do revision? :emo:
Reply 7586
Avatar for Skwee
Skwee
*had an epiphany today when she was allowed to get her dirty hands on a transducer for a heart ultrasound for the first time*

Amagawddd, it was so exciting! That **** actually works! :biggrin: *partayyyy*
Reply 7587
Avatar for SMed
SMed
11
I've had to return books that were being held.
Original post by crazylemon
Oh I hate gunners. It is so satisfying when you beat them and then they think you are mad for wanting to be a GP.


Mate, I genuinely think GP is my calling. I started off wanting to go into Neuro, did Neuro in year 2 and hated it, so that was then scrapped. Then I was sure it was O&G, but the stressful nature of the job and fear of litigation scares me. That, and everyone will just think I'm "following daddy's footsteps" if I did do that. :/ Then I thought Anaesthesia or Emegency Med, and this really hasn't been repressed just yet, but this BSc is really making me consider becoming a GP with a special interest, most probably with something to do with teaching/education. I actually don't know what I want to do (which I suppose isn't that strange a predicament). That said, I am almost certain that I DON'T want to do Psych - it is very emotionally draining according to my sister. She does have good hours though.

I wonder when med students decide what speciality they want to go into. I suppose there's no real rush to do so until final year/F1, but surely you could start looking into your potential speciality choice now, or am I beginning to sound like a gunner? :p:
Also, by gunners are you referring to the keen students who sit at the front of the lecture theatre always answering/asking questions etc? Or the uber competitive ones who are nice to you in person and then Facebook message you after every exam asking how you scored and how that compares with their score? Grrr. Annoying!
Original post by Medicine Man
Also, by gunners are you referring to the keen students who sit at the front of the lecture theatre always answering/asking questions etc? Or the uber competitive ones who are nice to you in person and then Facebook message you after every exam asking how you scored and how that compares with their score? Grrr. Annoying!

It's the sneaky ones that are more annoying than the overt ones.
Original post by Medicine Man
Mate, I genuinely think GP is my calling. I started off wanting to go into Neuro, did Neuro in year 2 and hated it, so that was then scrapped. Then I was sure it was O&G, but the stressful nature of the job and fear of litigation scares me. That, and everyone will just think I'm "following daddy's footsteps" if I did do that. :/ Then I thought Anaesthesia or Emegency Med, and this really hasn't been repressed just yet, but this BSc is really making me consider becoming a GP with a special interest, most probably with something to do with teaching/education. I actually don't know what I want to do (which I suppose isn't that strange a predicament). That said, I am almost certain that I DON'T want to do Psych - it is very emotionally draining according to my sister. She does have good hours though.

I wonder when med students decide what speciality they want to go into. I suppose there's no real rush to do so until final year/F1, but surely you could start looking into your potential speciality choice now, or am I beginning to sound like a gunner? :p:


:biggrin:
Told myself I would be productive today and catch up on my notes for CR.

Gone through one lecture. Only one ****ing lecture :sigh:

Really want to get it done before we start met but can't stop procrastinating :cheers:
Reply 7593
Avatar for Vulpes
Vulpes
15
Original post by Penguinsaysquack
Told myself I would be productive today and catch up on my notes for CR.

Gone through one lecture. Only one ****ing lecture :sigh:

Really want to get it done before we start met but can't stop procrastinating :cheers:


Haha. Don't worry :console:

Told myself the same thing. Fell asleep after ~10 slides on medical genetics.
Original post by Vulpes
Haha. Don't worry :console:

Told myself the same thing. Fell asleep after ~10 slides on medical genetics.


Common side effect of medical genetics.

I swear in FunMed I slept through more genetics lectures than I was awake in.. and even then I wasn't exactly attentive :erm:

Medicine would be awesome if you removed all the work :redface:
Original post by Vulpes
Told myself the same thing. Fell asleep after ~10 slides on medical genetics.


Is it bad that I actually enjoy genetics...
Reply 7596
Avatar for Vulpes
Vulpes
15
Original post by Penguinsaysquack
Common side effect of medical genetics.

I swear in FunMed I slept through more genetics lectures than I was awake in.. and even then I wasn't exactly attentive :erm:

Medicine would be awesome if you removed all the work :redface:


Without a doubt. :yep:


Original post by Lantana
Is it bad that I actually enjoy genetics...


:eek:
Original post by Vulpes

:eek:


Well there are some odd people on here who enjoy metabolism :lol:
Original post by crazylemon
True but the fines cap at a low point. Would make you an epic douchebag
Plus people never seem to hold books. I have had a textbook there is only one copy of at central for 2 months (not read) an no one has bothered to put it on hold...

Oh I hate gunners. It is so satisfying when you beat them and then they think you are mad for wanting to be a GP.



It is a terrible thing to do but I believe in Karma :smile: thankfully no one here is that competitive.

But the books here get taken awfully fast when a lecturer recommends it/on reading list or you need it for an SSC. I'd never even known where the section for all the meta-analyses/systematic reviews was in the clinical library... but come SSC essay time, it was super busy! Only managed to get the ones I needed 4 days before essay had to be in because so many people had put holds on them.

Out of curiosity when do you do your GP rotation? (I did mine in 3rd year but think it should be one of the senior blocks as it nicely brings together everything you've learnt over the course of 5 years and it's pretty much OSCE revision :tongue:).
Original post by Lantana
Is it bad that I actually enjoy genetics...


I do too... my iBSc is in medical genetics :frown: (to be honest I was attracted by the cardiac damage element of it as I'm interested in cardiology) but after sitting in clinics with supervisor - its amazing how one genetic mutation, if you think about how small a piece of chromosome is - and one tiny tiny part of that is mutated but it can manifest itself in patients so explicitly.

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