List of Medical Terminology
ABG: Arterial Blood Gas. A lab measurement of,
among other things, the pH and oxygen concentration of arterial blood; the
procedure is known as an “arterial stick.”
ACLS: Advanced Cardiac Life Support. A protocol
developed in the 1990s that involves the use of drugs, cardiostimulators, and
sequenced flowcharts to correct most cardiac dysrhythmias. A modern
version of this protocol is still in use today. For the complete ACLS
algorithm, see the ACLS reference elsewhere in this guide.
AED: Automated External Defibrillator, the
precursor of the cardiostimulator. A device
developed in the late 20th century to allow untrained laypeople to effectively
treat cardiac arrest patients, using computerized analysis and treatment
algorithms to provide fast, effective cardioversion without the need for a
trained EMT.
Agonal: Description of a major
negative change in a patient's condition, usually preceding immediate death;
examples include cessation of breathing, loss of pulse(s), or a dire change in
the patient's EEG or ECG.
AMA: Against Medical Advice. If a medical officer
tells you to stay in Sickbay and you leave anyway, you're leaving Against
Medical Advice. Usually an AMA departure involves the signing of a release form
absolving the medical staff of responsibility if the patient's condition
deteriorates after he/she leaves.
Ambu-bag: A handheld
squeeze bag attached to a face mask, used to ventilate patients; also known as
a bag-valve-mask device. See "bagging."
Amp: Abbreviation for ampoule, a single-dose
sterile vial of a given medication.
Anterior: Reference to the
front of something - a body surface, an organ, etc.
AOB: Alcohol on Breath. Now discouraged in favor
of “alcohol-LIKE odor on breath.” (After all, it could be
synthehol...)
Apnea: The absence of
respiratory effort (i.e. patient not breathing). Apnea is, for obvious
reasons, a life-threatening condition.
Appy: Abbreviation of appendectomy, an emergency procedure done on many species of
humanoids to remove an inflamed and/or infected appendix.
Asystole: The absence of all
activity in the heart, characterized by a flatline ECG. Asystole is nearly impossible to restore to normal
rhythm, and is almost universally fatal.
Arrhythmia: Any one of a number of
ways the heart can beat abnormally.
Arrhythmias are usually classified by where they originate (sinus,
supraventricular, atrioventricular, bundle branch) or what they cause (block,
tachycardia, bradycardia, fibrillation).
Attending physician: A fully licensed
and boarded physician who has staff privileges at a given hospital.
Depending on their field of specialty, attendings either work full-time in
shipboard Sickbays or take emergency call for their specialty services
(cardiology, OB/GYN, surgery, etc.) Attendings supervise and direct the
education of residents.
Babinski's reflex: Also known as the
plantar reflex, stimulated by stroking a pointed object (back of a knife, tongue
depressor, etc.) up along the medial aspect of the sole of the foot. If the toes (especially the great toe) curl
down, this is a negative Babinski, and indicates normal motor cortex function. In a positive Babinski, the toes splay
outward; this is a sign of severe, diffuse brain damage, and carries an
extremely poor prognosis.
BAC: Blood alcohol
content, the measure of ethanol in the bloodstream. BAC can be expressed
two ways, as a direct measurement in milligrams per deciliter (mg/dL), or as a
percentage. By calculating backwards, you can sometimes correlate BAC and
the number of alcoholic drinks the patient consumed. 100 mg/dL (.10) is
considered legally intoxicated; 350 mg/dL (.35) or above is considered alcohol
overdose, and requires urgent medical care.
Bag
'em; bagging: To use a bag-valve mask to
ventilate a patient. See "Ambu-bag."
Bag of worms: Synonym for ventricular fibrillation or "V-fib";
so named because the heart's action looks like a bag full of wriggling
worms. (No, we're not making this up.)
Blade: Derogatory term
for a surgeon; used by everyone, but has a special
meaning for anesthesiologists and nurses (who have to put up with surgeons'
bluster all day long and hence particularly enjoy getting their own
back). Blades take no advice from anyone, are never wrong, never admit to
being wrong even if proven so, know everything there ever is, was, and will be
about medicine, can do any surgical procedure while comatose with both hands
tied behind their backs, are completely invulnerable to such human needs as sleep,
nutrition and elimination, and generally conceive of themselves as seated at
the right hand of the Almighty.
Blow a vein: To make a vein
unsuitable for IV placement, due to repeated previous IV attempts or placements
in the same location.
BLS: Basic Life
Support. The basic care given to any unconscious patient, consisting of
airway maintenance, artificial respiration and chest compressions. BLS is
sometimes referred to as "professional rescuer CPR."
Bolus dose: A high dose of a given drug, usually
administered through an IV line, to achieve a rapid therapeutic effect.
Bones: Orthopedic
surgeons, doctors who specialize in the surgical treatment of bone
problems. Most medical professionals look down on orthopedics due to its
perceived preponderance of mentally challenged ex-jocks. (Many medical
schools have a persistent rumor that states that the bottom 10% of any given
class of students will be lobotomized; those who can crawl away afterwards are
destined for orthopedics.)
Bounce-back: Someone who is seen again with the same
complaint shortly after being discharged. You'll hear this as a
"bounce-back [complaint]."
BP: Blood pressure. BP is written as two numbers;
the first represents the pressure inside the arteries during contraction of the
heart (systole), and the second during relaxation (diastole) of the heart.
There are two ways to take a blood pressure, one involving the use of a machine
and the other involving the use of a stethoscope and a compression cuff. If it's done the second way, the pressure
will be in even numbers only. Normal
blood pressure in a human is around 120/80 mmHg; hypertension is defined as
systolic blood pressure of higher than 150 mmHg.
Bradying down: Bradycardia is a slow (less than 40
beats/min) heart beat. Bradying down is the slowing of the heart rate. See
"tachycardia" for the opposite effect.
Buff: To give a patient
the basic treatments, i.e. IV fluids and oxygen, to make their conditions look
as good as possible. Buffing is typically done as preparation for a
"turf," or right before an intern has to present the day's cases to
his or her attending.
Bug juice: IV antibiotics;
usually refers to high-powered drugs used to eradicate particularly nasty
infections.
Caesarean section
(C-section): Surgical delivery of a baby through the abdominal wall. C-section is indicated in certain situations (i.e. breech
presentation, in which the baby does not turn around in utero) where a
normal labor and delivery would endanger either the mother or the baby.
Call: Duty in
Sickbay. A physician "takes call" for a certain shift; that
physician is then "on call" and will be "called" for any
and all problems related to his or her specialty. Call typically rotates
among a number of doctors in a given specialty, according to a pre-determined
call schedule.
Cardioversion: Conversion of a
cardiac arrhythmia to normal sinus rhythm, usually accomplished by means of
electrical shock and drugs. See "defibrillation" for a specific, well-known
form of cardioversion.
CBC: Complete Blood Count (not Canadian
Broadcast Corporation, at least not here.)
It's the first test most ED doctors order for the vast majority of their
patients, due to its extreme usefulness in determining a patient's condition. A
CBC includes red cell and white cell counts (which may be further
differentiated into the types and amounts of white blood cells; this is known
as a "WBC diff"), hematocrit, hemoglobin, and some determinations
calculated from those values. Those determinations are the mean corpuscular
volume (MCV), the mean corpuscular hemoglobin (MCH), and the mean corpuscular
hemoglobin concentration (MCHC).
Cervical spine
(C-spine): The first seven vertebrae
in the spine, going from the base of the skull downward. A "C-spine
collar" is a stiff collar used to immobilize the C-spine in patients with
suspected spinal trauma. A "cross-table C-spine" is a kind of
scan taken laterally across the body to check for fractures of these vertebrae,
a common occurrence in traumatically injured patients.
Champagne tap: A successful lumbar puncture with no red
blood cells found, which means it is as clean as possible. By custom, if a medical student or intern
makes a champagne tap, the resident or attending must buy him or her a bottle
of champagne.
Chem 7, Chem 20: Blood chemistry series used to measure blood
urea nitrogen (BUN), serum chloride (Cl), CO2, creatinine, glucose, serum
potassium (K), and serum sodium (Na). A Chem 20 is far more extensive, and
measures (in alphabetical order): albumin, alkaline phosphatase, ALT, AST, BUN,
serum calcium, serum chloride, CO2, creatinine, two bilirubin determinations,
gamma-GT, glucose, LDH, serum phosphate, serum potassium, serum sodium,
cholesterol, protein, and uric acid.
Coag panel: A blood test used to determine the efficacy
of the clotting factors in a patient's blood.
Code
Blue:
Medical emergency code, called to indicate that a patient is not breathing,
does not have a pulse, or any combination thereof. When announced over a
hospital PA system or a ship's all-call, the format is "Code Blue, [location]";
all available medical personnel are then required to respond to the code.
A patient on whom a Code Blue is called is said to have "coded;" the
process of resuscitating a coded patient is called "running a code."
DNR patients, for this reason, are sometimes referred to as "no
codes."
Code Brown: Derogatory
"code," indicating that a patient with gastrointestinal upset didn't
make it to the facilities in time.
Code Pink: Emergency code
indicating an emergency in the nursery or NICU. Code Pinks are usually
called when an infant's ID bracelet does not match up, when an infant is
threatened or abused, or when an infant goes missing.
CPR: Cardiopulmonary Resuscitation, or the
technique of systematically squashing someone’s chest to simulate cardiac
function. We cannot recommend strongly enough that you take a course in it.
A six hour investment might help you save somebody's life someday. If it's
been more than a year since you've done the course, your certification has
expired. To stay certified, you need to take it every year.
Crack the chest: To perform an
emergency thoracotomy on a patient.
Crash: To have one's
condition take a sudden and severe turn for the worse. Usually refers to
trauma patients whose "Golden Hour" has run out, i.e. "The GSW
in Room 4 is crashing!"
Crasher: Irreverent slang term for a family member or
loved one of an ED patient who passes out in shock at learning of the patient’s
condition.
Crispy critter: Irreverent ED slang for a severely burned
patient.
Crit: Hematocrit, or the height of red blood cells
over the plasma in a centrifuged tube, expressed as a percentage. Since red
blood cells carry oxygen to the tissues of the body, this is a useful
measurement of how well the blood is doing its job.
Cross-clamp(ing): The aorta, the main oxygenated artery leading
from the heart, has two parts, one going up and one going down, called the
ascending and descending aorta respectively. During a thoracotomy, the
descending aorta can be clamped off to control hemorrhage below the diaphragm.
This process conserves blood while preserving perfusion to the heart and brain,
but obviously compromises circulation to the lower body.
CTD: Circling The
Drain. Derogatory term for a patient who is extremely sick and not likely
to recover.
CxR: Chest x-ray.
D5W: A commonly used intravenous solution (not
motor oil - that would be 10W30.) D5W and its ilk are various amounts of
dextrose (a simple sugar, also known as glucose) in water. D5W is 5% dextrose; D10W is 10% dextrose, and
so on.
Debridement: Cleaning an open wound by removing foreign
material and dead tissue. In some cases, it can be painful enough to
require sedation.
Decerebration: The progressive loss of cerebral function;
advanced decerebration (and the resultant deep unconsciousness) occurs with
severe damage to the cerebrum, the largest part of the brain. A totally
decerebrated patient is said to be brain dead.
Deep: That which is
located deeper within the body than a given reference point, i.e. "the
heart is deep to the ribs."
Defibrillation: The cessation of fibrillation (chaotic,
ineffective “wriggling” beat) of the cardiac muscle and restoration of a normal
rhythm, usually accomplished by means of electrical shock and drugs.
(Incidentally, medical personnel yell "Clear!" for a very good reason
when shocking a patient. Remember that the human body is mostly water
with some salt, and that saline solution is a very good conductor of electricity...
hence whatever or whoever touches the body will get shocked as well.)
Differential diagnosis: A list of every disease that may possibly
cause your patient’s symptoms. Typically
when making a diagnosis, you will start out with as large a differential as
possible and narrow it down to the one disease most likely to cause the
observed symptoms.
Disaster protocol color
coding: The use of color codes to rapidly triage
mass-casualty patients for examination or treatment:
Green = walking wounded; last to be seen
Yellow = urgent; can wait a few hours for treatment
Red = critical; treat immediately
Black = DOA
DKA: Diabetic
ketoacidosis, a life-threatening complication of hyperglycemia.
DOA: Dead on Arrival. Enough said.
Doc: A physician,
short for "Doctor." When used by a student or resident in
reference to an attending, it indicates that said attending is well liked and
highly respected, i.e. "Dr. Kirtschner is a good doc; she's on the ball,
she doesn't pimp too badly, and she's pretty decent for a blade."
Dorsal: Reference to the
back of a person (as opposed to "posterior," which refers to any rear
surface).
DPL: Diagnostic peritoneal lavage. Saline is
infused into the peritoneum (abdominal cavity), then suctioned out. The
presence of blood in the resultant fluid is an indication for surgical
exploration of the abdomen. It's not a
pleasant procedure, but it can save a great deal of time and avert a good many
surgical complications.
DNR: Do Not Resuscitate. A legal advance directive filed by some
patients, especially those with terminal illnesses, ordering that no heroic
measures be undertaken by medical personnel to save their lives in an
emergency.
DVT: Deep vein thrombosis - a blood clot in a deep
vein. A dangerous condition because the
clot can travel up to the heart or lungs and block a vessel feeding those
organs, causing cardiac or pulmonary ischemia, cardiac arrest and death.
ECG: Electrocardiogram - a graphic representation
of electrical activity in the heart. A proper ECG uses twelve leads to produce
twelve tracings, and is called exactly that - a 12-lead ECG. ECG can
diagnose conductive problems in the heart, localize ischemic damage in MI
patients, and indicate the presence of some traumatic and pathological
conditions (i.e. torsades de pointes, a fatal arrhythmia, often occurs
in drug OD).
ED: Emergency
Department. (Other variations on this abbreviation include
"ER", "EW", "EU", "EC", which stand for
emergency room, ward, unit, center, etc.) Often derogatorily referred to
as "The Pit" by those who work there.
Edema: Fluid accumulation in tissues. Crackling sounds in the chest are a
characteristic finding of pulmonary edema, or “wet lungs.”
EEG: Electroencephalogram. Graphic representation
of brain activity. See ECG for its cardiac equivalent.
EMT: Emergency Medical
Technician, commonly referred to as a medtech. EMTs come in two
varieties, classified by the kind of care they can provide: basic (BLS,
first response, evaluation and transport) and advanced (ACLS, some drugs,
evaluation and transport).
Endoscopy: Use of a
flexible, fiber-optic scope to see inside the body, usually via the
gastrointestinal and respiratory tracts. Endoscopy has been available
since the 20th century as a diagnostic and therapeutic procedure; with the
advent of modern, non-invasive scanning techniques, it is typically only used
when biopsy of deep tissues is required to make a diagnosis, i.e. ruling out
cancer in a patient with colon polyps.
Endotracheal intubation: The placement of
a plastic tube through the mouth and into the trachea (windpipe) to establish
an airway into the lungs and provide a means of ventilating patients who cannot
breathe on their own. An instrument called a laryngoscope is used to see
inside the throat and ensure that the tube goes into the trachea
correctly. The tube is known as an ET tube or airway; the procedure is
called either RSI or "tubing."
EtOH: Ethanol (ethyl
alcohol), the active ingredient in alcoholic beverages. When written as a
chief complaint, it indicates that the patient has had too much to drink.
4F: A patient in whom
you strongly suspect gallbladder disease. The abbreviation (which is
slightly irreverent) refers to the four major risk factors for
cholecystitis: Female, Forty-ish, Fat, and Fertile.
400 Club: The subset of
alcoholic patients who have presented to Sickbay with a blood alcohol level
above 400 mg/dL. 400 Club members are usually spoken of with a kind of
grudging respect, as for most individuals, that much alcohol is sufficient to
induce unconsciousness.
Flatliner: A patient in asystole; one whose ECG shows only a flat line,
indicating a dead patient.
Flail chest: Traumatic
condition in which multiple rib fractures create a "floating" section
of chest wall that impedes breathing. Flail chest is a life-threatening
emergency.
FLK: Funny-Looking
Kid. Derogatory term, in pediatrics, used to refer to a child who appears
to have some congenital or developmental abnormality.
Flog: A code gone horribly wrong due to massive medical
error, or one in which the patient never had a hope in the first place.
Unusually bad flogs are also called "horror shows."
Foley cath: A type of indwelling urinary catheter, placed
through the urethra and into the bladder, used to drain the bladder in patients
who cannot get themselves to the facilities. (Foleys are not pleasant for the
patient... you can probably figure out why.)
Frequent flier: Derogatory term
for a patient who reports to Sickbay far more often than is good for him/her.
Gas passer: Derogatory term
used by surgeons to refer to anesthesiologists,
who (according to surgeons) do nothing but collect outrageous fees for playing
with mind-altering gases. (The reference to flatulence is
intentional.) For the retort from Anesthesia, see "blade."
Gomer: Get Out Of My Emergency Room.
Derogatory term for a patient you really don't want to deal with. The
"definitive" gomer is usually elderly; suffers from a boatload of
terminal illnesses, any one of which may be acting up at the moment; is usually
senile; and is practically indestructible. More generally, gomers are
patients with minor, irritating complaints for which you're paged out of
bed. ("...And what exactly made your ingrown toenail require urgent
medical care at
Goop: Conductive gel - that stuff that gets dumped on
the paddles of the cardiostimulator before shocking the patient. Used so the
patient on the receiving end doesn't get the skin burned off his or her chest,
which is obviously Not a Good Thing.
Gork: God Only Really Knows. A patient who is extremely sick and usually
moribund, usually for reason or reasons unknown. Such a patient is often said
to be "gorked out." Derogatory when used in reference to a
patient.
GSW: Gunshot wound. (You’ll
also see PW, phaser wound, though less often.)
A hazard of modern life.
Haldol: Trade name for haloperidol, a commonly used
neuroleptic sedative. Quite possibly the most useful drug in emergency
medicine, it's also known as Vitamin H.
Hyperglycemia: Abnormally high levels of glucose in the
blood, a key sign of diabetes. If the blood sugar goes too high, diabetic
coma and DKA can result; either can be fatal.
Hyperlipidemia: Excessive fat in the blood. Usually used to refer to high blood levels of
cholesterol and other triglycerides, which is a risk factor for atherosclerosis
and MI.
Hypertension: Abnormally high blood pressure.
Hypertension is a risk factor for all kinds of diseases, including but not
limited to heart disease, MI, CVA and aneurysm.
Hypoglycemia: Abnormally low levels of glucose in the
blood. Usually the patient presents with
“weak and dizzies” from skipping meals.
Hypotension: Abnormally low blood pressure. Too low
and the patient faints. (You can induce low blood pressure in yourself by
the following neat trick: Lie down on a flat surface and remain still for
about ten minutes. Now stand up quickly, and try not to fall down.
The lightheadedness you feel is a kind of low blood pressure called orthostatic
hypotension.) Other causes of hypotension include trauma (i.e. hypovolemia),
drug overdose and shock.
Hypothermia: Body temperature significantly below normal.
Hypovolemia: A decrease in the volume of circulating
blood, almost always as the result of trauma; also referred to as being in
shock. Hypovolemia is a life-threatening condition, and is treated with
IV fluids and hemolog transfusion.
Hypoxia: A severe deficiency of oxygen in the blood
and tissues. Hypoxia leads to ischemia; ischemia leads to tissue death.
If a patient has a PaO2 of less than 90% on normal air, hypoxia is likely; give
oxygen by mask or nasal cannula, or intubate if the condition warrants.
ICP: Intracranial Pressure. The humanoid brain
floats in a fluid-filled space, enclosed by bone; when the pressure goes up,
the fluid cannot be compressed, so the brain gets squeezed (this is not a good
thing). Increased ICP is one of the
results of blunt trauma to the head, among other things.
IM:
Intramuscular. An injection given into a muscle as opposed to into a vein
(IV). IM injections do not take effect as quickly as IV, as the drug
takes longer to reach systemic circulation, but they tend to last longer than
IV injections for the same reason.
Inferior: That which is
below a given reference point, i.e. "the stomach is inferior to the
esophagus." The term does not indicate that something is bad or
substandard, just physically below the reference.
Intern: A first-year
resident. An internship lasts one year and is the minimum amount of post-MD
training required to obtain a license to practice medicine. Many residencies do
not count the intern year as part of the residency, and some (ophthalmology
being one example) require the intern to reapply for his or her residency at
the end of the year. Interns typically supervise medical students and co-sign their
charts.
IOP: Intraocular
Pressure. The humanoid eye contains a certain volume of fluid, known as
aqueous humor, which circulates in the front of the eye (the anterior chamber)
and nourishes the tissues therein. Too much aqueous results in high IOP,
most commonly seen in the context of glaucoma; low IOP usually results from a
leak of aqueous, as in an open globe injury. Both are sight-threatening
conditions and need immediate treatment.
Ischemia: Condition in which the tissues are starving
for oxygen due to inadequate blood circulation.
Ischemia is more serious in some tissues than in others; in the brain,
ischemia lasting more than four minutes indicates certain brain damage, and the
heart can only sustain 90 minutes of ischemia before dying.
IV:
Intravenous. Can be used to refer to a line for injection of fluids and
medications, or the injection itself. IV injections tend to take effect
very rapidly.
IV push: A bolus dose of a medication as quickly as
possible through an IV port. IV push is used when a medication must take
effect very rapidly, as in ACLS.
Lac: Laceration.
A cut in any tissue, usually as a result of sharp object trauma.
Lasix: Trade name for
furosemide, a diuretic (i.e. causes patient to urinate). The name derives
from the fact that the drug's effect lasts six hours. (Not
to be confused with LASIK, which is an acronym for Laser In-situ Keratomileusis
- a kind of eye surgery.)
Lateral: That which is
further from the midline than a given reference point, e.g. "the arm is lateral
to the chest."
Lavage: Washing out. See "DPL" for a specific example. Other
cases include gastric lavage in cases of poisoning or upper GI bleeding.
LGFD: Looks Good From Doorway
- derogatory term for a patient who, despite complaints to the contrary, does
not appear to be acutely ill or injured. Usually used to refer to a
malingering patient or a hypochondriac.
Liver rounds: A tradition in
nearly all hospitals and Sickbays, wherein the doctors and nurses go hang out
in the local bar of their choice at the end of the day on Friday. (The
term derives from the fact that alcohol is metabolized by the liver.)
LOC: Level of Consciousness, or Loss of
Consciousness.
LOL in NAD: Little Old Lady
in No Acute Distress - an elderly woman who has nothing acutely wrong with her,
but has come "just to get checked out." You won't see this too
often in a shipboard Sickbay, but it's extremely common in civilian hospitals.
Mass-cas: Mass casualty; a
situation in which a disaster occurs and creates a large number of injured
patients who then must be seen and treated as rapidly as possible. Aboard
ship, a mass-cas is almost synonymous with a battle, as any attack that damages
the ship is guaranteed to injure at least one crewperson, and probably more.
Medial: That which is
closer to the midline of the body than a given reference point, e.g. "the
nose is medial to the eyes."
Medical student: A person in the
process of obtaining his or her MD. Technically, only third- and fourth-year
students who have passed Phase I of the licensure exam may work with patients;
however, many programs now also allow the more junior students to spend
supervised time on the wards as well. Interns supervise medical students
and co-sign their charts, along with an attending.
MI: Myocardial infarction, sometimes called an
AMI (the "A" standing for "acute"). Blockage of a coronary
artery as a result of plaque formation cuts off the oxygen supply to the heart muscle,
and causes severe chest pain as the muscle becomes ischemic and begins to die.
If enough of the heart muscle dies, the patient dies too. MI is commonly
known as "heart attack." See also “TPA.”
M&M: abbreviation for
Morbidity and Mortality, a conference held by many departments on interesting
cases that ended either with some unforeseen complication (morbidity), or death
(mortality). Most M&M conferences are held as teaching lectures, to
determine what went wrong with a patient and how to avoid the same thing
happening again. More malignant programs use it to embarrass physicians
and their mistakes. If refreshments are served, often the nickname is Death and
Donuts (D&D).
MRI: Magnetic Resonance Imaging - a form of
imaging study that produces detailed pictures of internal organs.
MRIs are extremely useful in trauma cases for assessing the amount and nature
of internal injury.
MVA: Motor Vehicle
Accident. Can refer to two vehicles crashing, or a vehicle hitting
something else, i.e. ground car vs. pedestrian.
NAT: Not A
Trooper. Derogatory term used for a trauma patient who is screaming,
uncooperative and generally not bearing with his or her injuries like the model
Starfleet serviceperson.
NG tube: Nasogastric tube;
a tube placed through the nose, down the throat and into the stomach. It's
about as much fun as it sounds.
(Derogatorily, it’s “up your nose with a rubber hose.”) In the ED, it's used for gastric lavage and
emptying of the stomach in cases of accidental ingestion.
NMB: Neuromuscular
blockade - a drug-induced dissociation between the nervous impulses and the
body's reactions to them. NMB is typically induced in cases where a patient
must be completely immobile to avoid doing himself inadvertent injury, as in
surgery, or when reflex muscular actions make a time-critical procedure
difficult or dangerous, as in endotracheal intubation. See “RSI” for more information.
Normal sinus rhythm: A normal heart rate and rhythm, which is
between 60 and 80 beats per minute in an adult human.
Nosocomial infection: Opportunistic infections contracted while in
the hospital, e.g. a urinary tract infection a patient develops from his Foley
catheter.
NPO: Nothing by mouth (from the Latin Nil per
os). Typically written as a
pre-operative order, where eating before surgery can have serious
complications.
NS:
NSAID:
Non-steroidal anti-inflammatory drugs, an extremely useful class of
medications. NSAIDs are typically non-prescription drugs, and can be used
to treat just about any combination of pain (including headache), swelling and
fever. The old medical joke "Take two of these and call me in the
morning" was probably said in reference to aspirin, one of the first
NSAIDs.
O neg: Type O-negative blood, called “universal
donor” because it contains no amounts of the common A or B antigen. In humans
and many other species, four blood types exist:
A, B, AB and O. For each blood
type, the immune system makes antibodies to the antigen the blood doesn't have;
A-type patients have antibodies against B-type, B against A, O against both,
and AB against neither. Giving A-type
blood to a B-type patient, for example, will cause an agglutination reaction, a
fatal condition in which the blood clumps (agglutinates) and clots throughout
the body. The negative relates to the Rhesus factor, a second antigen that must
also be matched to avoid this outcome. Patients who are Rh+ can take either
type of blood; Rh- patients have antibodies against Rh and can only take Rh-
blood. You can use O+ blood in place of
O- in any Rh+ patient. Note that most
shipboard Sickbays carry hemolog, a synthetic blood replacement, instead of
actual blood; only a few rare conditions require actual blood transfusions.
O
sign:
Derogatory term, indicating that an unconscious or moribund patient's mouth is
hanging open. See also "Q sign."
OD: Overdose; usually
on medications, alcohol or recreational drugs.
OTC: Over the counter;
any medication that can be obtained without a prescription. NSAID pain
relievers and respiratory decongestants are two examples of OTC medications.
Papilledema: Swelling of the optic disk in the back of the
eye, a good indicator of increased ICP.
PE: Pulmonary embolus
- a thrombus (blood clot) that lodges itself in one of the pulmonary arteries,
the vessels that carry blood to the lungs to pick up oxygen. If the clot
blocks the artery sufficiently, the blood can no longer make it to the lungs,
and hypoxia results. Treatment consists of TPA, respiratory therapy with
drugs and ventilation, and (rarely) surgical clot removal with nanites.
PET: Positron Emission
Tomography. An imaging technique even better than MRI for observing the
dynamics of and blood flow to the tissues under study. Great for patients
in whom you're trying to assess ischemic damage, but also incredibly
power-hungry (and hence incredibly costly).
Pimp: Acronym for Put
In My Place (not a purveyor of the services of prostitutes).
Pimping is a belittling "teaching" practice, perpetrated by
attendings or residents on students or interns, consisting of asking
increasingly difficult questions of the student in an attempt to make him or
her look stupid.
Pit: Irreverent ED
slang for the Emergency Department itself.
PRN: As needed (from the Latin pro re nata). Typically written in prescriptions to
indicate that the patient may take the drug whenever the patient's symptoms
require it.
Q
sign:
Similar to the O sign, but with the addition of the patient's tongue hanging
out of the mouth (hence forming a "Q" shape). An ominous sign,
particularly in gorks and gomers. Like "O sign," this is a derogatory usage.
Rays: Radiologists, a
category of physicians universally ridiculed by their peers because they make
pretty pictures of the body that may or may not have any bearing at all on a
patient's condition.
Resident: A physician in
the process of completing his or her training in a given specialty.
Residents are ranked by seniority; most residencies run three to five years.
Residents supervise interns and medical students, and sometimes each other.
ROS: Review of
Systems. The basic physical exam, covering every bodily system and
usually including some degree of blood work.
Round up the usual
suspects:
To order a "shotgun" panel of lab tests on a patient whose condition
cannot be immediately diagnosed. A "roundup" usually consists
of a CBC with WBC diff, a Chem 20, an LFT (liver function) panel, blood
cultures, cardiac enzymes, urinalysis, and chest scans.
RSI: Rapid Sequence Intubation. The preferred way
of intubating a patient in the emergency department, involving the use of
paralytic drugs to induce apnea (absence of respiration) and to suppress the
gag reflex. The induced neuromuscular blockade lasts only a few minutes,
and the patient suffers no ill effects.
SC: Subcutaneous (the
spoken abbreviation is "sub-Q"). An injection given just under
the skin, where it can reach the systemic circulation very quickly and yet have
a long duration of action. SC epinephrine is often used to treat allergic
reaction.
Scut: Mundane daily
tasks such as blood draws, vital-sign checks and chart notes; usually done by
(and often heaped upon) the lowest person on the totem pole in Sickbay.
Sometimes taken as an acronym for "slightly clinically useful
training."
Shock: A circulatory disturbance caused by a number
of factors; when induced by bleeding, it’s hypovolemic shock or traumatic shock. Shock is marked by a severe drop in blood
pressure, rapid pulse, clammy skin, pallor, and a rapid heart rate.
Stat: Immediately (from the Latin statinum). Most medical personnel hate this term with a
passion.
Studying for the final
exam:
Derogatory term used to refer to a patient, usually terminally ill, who has
taken a sudden interest in religion.
Superficial: That which is
closer to the surface of the body than a given reference point, i.e. "the
skin is superficial to the bone." A superficial injury is one that
does little damage beyond the skin and subcutaneous tissue.
Superior: That which is
above a given reference point, i.e. "the head is superior to the
neck." The term does not indicate that something is good or better
than average, just physically above the reference.
Tachycardia: Rapid heart beat. Sinus tachycardia (normal
rhythm, just an accelerated beat) is more than 120 beats/minute; ventricular
tachycardia is a life-threatening arrhythmia that requires immediate correction
(and is, along with ventricular fibrillation, a leading cause of death in
arrest patients).
TCAB: Torpedo Casing At
Bedside. Derogatory code indicating that a patient is expected to die
soon. See also "CTD."
Thoracotomy: Emergency surgery that involves opening the
chest cavity to get at the organs inside.
There are two ways to do a thoracotomy: the first involves making
an incision between the fourth and fifth ribs on the left side and cranking the
ribs apart with a rib spreader, and the second (and more common) requires a
midline incision down the sternum (breastbone) and the use of a saw to split
the sternum down the midline, whereupon the rib spreader is used to open the
chest. The procedure is designed to directly expose the heart, lungs and
great vessels for immediate surgical repair.
It’s extremely gory, is only used as a last resort for traumatic chest
injury, and carries a rotten prognosis (although the rotten prognosis comes
more from the trauma than the procedure).
Tox screen: Analysis of blood toxins. A tox screen
will tell you what your patient took and how much of it, a useful thing to know
when treating an OD.
TPA: Properly tPA, it stands
for Tissue Plasminogen Activator, part of a class of drugs known as
thrombolytics (from the Latin thrombus, clot, and lysis, to
break). TPA and its ilk dissolve blood clots in the bloodstream.
It's similar to drain opener for your blood vessels. Historically,
thrombolytics have been given to heart attack patients, patients with
thrombotic emboli, and stroke victims, usually within six hours of the actual
ischemic event.
Trach: Slang for “tracheostomy,” a surgical
procedure used to establish an airway in a patient who cannot be intubated.
Train wreck: A patient who has
so many diseases and/or injuries that any hope for a cure is to be found
somewhere out in miracle territory.
Tube: Used alone, usually
referring to an endotracheal tube. As a verb, it means to intubate someone.
Turf: To transfer a patient
to the care of some other physician, usually one on another service. A great
way of making your day easier (unless, of course, you’re a shipboard CMO, in
which case it’s your patient anyway.)
Type and cross-match: Blood typing prior to transfusion.
Ventral: Reference to the
front (thorax, abdomen and pelvis) of a patient (as opposed to
"anterior," which only refers to a frontal surface).
V-fib: Ventricular fibrillation, a condition in
which the pulse is absent and the heart is in a chaotic, uncoordinated rhythm
(commonly called "bag of worms" because a heart in V-fib looks like a
bag full of small, squirming creatures).
V-fib is fatal unless treated immediately (see "ACLS" and "defibrillation").
V-tach: Ventricular tachycardia, a condition in which
the heartbeat originates in the ventricles (as opposed to the sinoatrial node,
where it should) and is abnormally fast (150-200 beats/minute). V-tach is also life-threatening and is
treated with drugs (see "ACLS").
WNL: Within
Zebra: A rare medical
condition, almost never seen outside of textbooks. The term refers to an
old medical dictum, "When you hear hoofbeats, think of horses, not
zebras"; the implication is that the patient's symptoms are more likely
due to some common ailment rather than an exotic one.