Fragile - Byourii Kishi Keiichirou no Shoken - Vol. 1 Ch. 1 - Mr. Kishi, He's An Important Person!
- Thread starter MangaDex
- Start date
Dex-chan lover
- Joined
- Jan 18, 2018
- Messages
- 666
i spent about 30 extra minutes looking up medical terms but it was a good/informative read. even if I'm not aiming for med school anymore, it's still good to recognize symptoms in case it happens to somebody. thanks for the translation (or do I thank kanjitomo and google translate?)
Hello, this is my first post on this site and as a 2nd year resident physician in the USA, I wanted to leave some comments. While I do not know how medicine works in Japan other than by reading a few medical themed mangas, I do have some questions regarding the "flow" of this medical case. Could it just be how the author's story played out or did they read a medical case report and wrote their story off of that.
Had we admitted the patient, things for sure would of played out differently. I'll explain our work up.
17 yo F, no Past Medical History, takes no prescription medications. Reports having nausea, fever, headache, discomfort in bilateral lower extremities with a 2 cm facial laceration after trauma occurred. It is unknown if symptoms occurred before or after the trauma or what caused pt to have the trauma. Pt is declining to answer if they had a loss of consciousness and then fell, or tripped and fell with injury to her head and LOC, or if pt had LOC. Pt denies having other symptoms.
CT Head: negative for acute bleeding. CBC, CMP WNL, no abnormalities. Hcg test (for a teen girl for sure order even if pt denies having a partner) assumed negative. Blood cultures pending (pt had fever, so you want to order these to rule out sepsis.
Physical exam: None of their team reports their physical exam findings. Those are really important. For someone who has a head injury, even if it's minor you still want to access them for trauma related findings. Pupil changes, neurologic findings (arm or leg weakness, facial nerves aren't moving the muscles correcting aka facial droop), fluid leaking from the ears, testing their arm and leg strength, testing their upper and lower extremity reflexes, etc.
Their work up was okay. They ordered the CT head, very important to see if she is bleeding intracranial. Wanting to order a MRI of the Spine to check for leg weakness.....I don't see a need for that had they done a good physical exam. Their working diagnosis of lumbar disc disease is no where near on my list of differentials for a female teenager. Disc disease tends to be in middle aged individuals who present with chronic pain in the arms or legs....because the nerves are being impinged by disc bulging.
My big question, is why a Pathologist was present during the case report? In the USA, pathology is mostly consulted for identification of biopsies from masses. My one patient I had today, had a biopsy taken from a thigh mass to which pathology was consulted to identify what it is. Then probably consult general surgery to remove the mass if it's benign or Heme/onc if it's cancerous.
The path's comment about the nausea and fever is good. You don't brush that off with "Tylenol fixed it", you need to investigate why they had those symptoms. Heat stroke, heat exhaustion, viral, sepsis?????
The one Dr wanted to Order an MRI of the hip....100% that wont show you anything regarding the girls problem.
The sudden twist of how she fell. No. You do a good, strong evaluation with the patient for your History and Present illness. IF the patient says she doesn't know how she fell or can't remember. She's a minor in the USA. So better believe I'm asking her who was with her and I'm calling them myself on the day of admission to find out more. That is extremely pertinent information.
Okay, new topic. TIA, triansient ischemic attack. What? I know the author thought they found something neat to diagnose her with. But that would be super rare in her age group especially when she doesn't have risk factors for it, likely not on birth control, doesn't having a clotting disorder, doesn't smoke.
Then the further work up. Ordering the Brain MRI, yah I would of ordered that a long time ago to rule out Meningitis. But to order it to rule out, TIA. No. A TIA wont show up on an MRI because it resolves. That's why it's a TIA and not a stroke. A stroke will show up on a MRI. And again, I'm still not sure why the Pathologist is involved. This is 100% in the realm of Internal Medicine and is something that they deal with. Also, consulting Neurology regarding a stroke work up.
Cervical Echo = I think they meant TransEsophageal ECHO which is something you do order for a stroke work up as you are checking the heart to see could the clot originated from the heart. In pediatrics, this is something I'm 100% on board with as teenagers can have undiagnosed heart conditions.
After the MRI brain is positive, I don't know why they are wheeling her down the hallway? There's no surgery to deal with a stroke. In the USA we have a 3-4 hour window from when a patient presents with stroke like symptoms to give them tPA, a clot buster drug. The pt was 26 years hours, very well beyond that point. At that time, management would be. "you had a stroke, we need to do a further work up to see why you developed a stroke at your age with your history. For now, it's physical therapy, aspirin and a atorvastatin to prevent further clot developments. You're staying in the hospital for a few more days. Possible discharge to inpatient rehab.
"It was immediately diagnosed as TIA" No. Wrong, it's not a TIA at that point lol. It's an Ischemic stroke with asymptomatic presentation.
"When she developed symptoms and the CT showed cerebral hemorrhage" Okay. So now she has an ischemic stroke with hemorrhagic conversion. Wow. I really hope Neurology got consulted.
If you read my post, thank you for your time.
Had we admitted the patient, things for sure would of played out differently. I'll explain our work up.
17 yo F, no Past Medical History, takes no prescription medications. Reports having nausea, fever, headache, discomfort in bilateral lower extremities with a 2 cm facial laceration after trauma occurred. It is unknown if symptoms occurred before or after the trauma or what caused pt to have the trauma. Pt is declining to answer if they had a loss of consciousness and then fell, or tripped and fell with injury to her head and LOC, or if pt had LOC. Pt denies having other symptoms.
CT Head: negative for acute bleeding. CBC, CMP WNL, no abnormalities. Hcg test (for a teen girl for sure order even if pt denies having a partner) assumed negative. Blood cultures pending (pt had fever, so you want to order these to rule out sepsis.
Physical exam: None of their team reports their physical exam findings. Those are really important. For someone who has a head injury, even if it's minor you still want to access them for trauma related findings. Pupil changes, neurologic findings (arm or leg weakness, facial nerves aren't moving the muscles correcting aka facial droop), fluid leaking from the ears, testing their arm and leg strength, testing their upper and lower extremity reflexes, etc.
Their work up was okay. They ordered the CT head, very important to see if she is bleeding intracranial. Wanting to order a MRI of the Spine to check for leg weakness.....I don't see a need for that had they done a good physical exam. Their working diagnosis of lumbar disc disease is no where near on my list of differentials for a female teenager. Disc disease tends to be in middle aged individuals who present with chronic pain in the arms or legs....because the nerves are being impinged by disc bulging.
My big question, is why a Pathologist was present during the case report? In the USA, pathology is mostly consulted for identification of biopsies from masses. My one patient I had today, had a biopsy taken from a thigh mass to which pathology was consulted to identify what it is. Then probably consult general surgery to remove the mass if it's benign or Heme/onc if it's cancerous.
The path's comment about the nausea and fever is good. You don't brush that off with "Tylenol fixed it", you need to investigate why they had those symptoms. Heat stroke, heat exhaustion, viral, sepsis?????
The one Dr wanted to Order an MRI of the hip....100% that wont show you anything regarding the girls problem.
The sudden twist of how she fell. No. You do a good, strong evaluation with the patient for your History and Present illness. IF the patient says she doesn't know how she fell or can't remember. She's a minor in the USA. So better believe I'm asking her who was with her and I'm calling them myself on the day of admission to find out more. That is extremely pertinent information.
Okay, new topic. TIA, triansient ischemic attack. What? I know the author thought they found something neat to diagnose her with. But that would be super rare in her age group especially when she doesn't have risk factors for it, likely not on birth control, doesn't having a clotting disorder, doesn't smoke.
Then the further work up. Ordering the Brain MRI, yah I would of ordered that a long time ago to rule out Meningitis. But to order it to rule out, TIA. No. A TIA wont show up on an MRI because it resolves. That's why it's a TIA and not a stroke. A stroke will show up on a MRI. And again, I'm still not sure why the Pathologist is involved. This is 100% in the realm of Internal Medicine and is something that they deal with. Also, consulting Neurology regarding a stroke work up.
Cervical Echo = I think they meant TransEsophageal ECHO which is something you do order for a stroke work up as you are checking the heart to see could the clot originated from the heart. In pediatrics, this is something I'm 100% on board with as teenagers can have undiagnosed heart conditions.
After the MRI brain is positive, I don't know why they are wheeling her down the hallway? There's no surgery to deal with a stroke. In the USA we have a 3-4 hour window from when a patient presents with stroke like symptoms to give them tPA, a clot buster drug. The pt was 26 years hours, very well beyond that point. At that time, management would be. "you had a stroke, we need to do a further work up to see why you developed a stroke at your age with your history. For now, it's physical therapy, aspirin and a atorvastatin to prevent further clot developments. You're staying in the hospital for a few more days. Possible discharge to inpatient rehab.
"It was immediately diagnosed as TIA" No. Wrong, it's not a TIA at that point lol. It's an Ischemic stroke with asymptomatic presentation.
"When she developed symptoms and the CT showed cerebral hemorrhage" Okay. So now she has an ischemic stroke with hemorrhagic conversion. Wow. I really hope Neurology got consulted.
If you read my post, thank you for your time.
Member
- Joined
- Mar 30, 2019
- Messages
- 295
Hey finally an update thank you so much!
- Joined
- Sep 30, 2019
- Messages
- 27
Thanks for the translation!
I really admire those who have the dedication to do a full chapter by themselves!
If you have trouble with some kanji, then jisho.org is a really good source. I mean. I only took Japanese one year in HS so it is not the best, but with jisho most things can be somewhat understood. I mean, I suck at kanji so XD
The example page would be something like:
"出たあああ！！！" ("It appeared!/It came out!" Often used for ghosts or monsters appearing, lol)
"ガタァ" (probably clattering from the chairs)
"うわああああああ" ("Uwaaaaa" screaming)
"妖怪カンファ荒らしだああ！！！" (maybe something about "the demon/ghost has come to wreck our conference/meeting"? No clue honestly. Altho I think it is super funny that they literally call him a ghost o a demon XD)
@gentay That was an interesting read. I didn't expect to learn something new from thos comment section, but I did. 🙂
I mean, unless the mangaka consults a professional, or is a professional themselves, it would be hard to get all of that. Plus it wouldn't make for good drama, probably....
I really admire those who have the dedication to do a full chapter by themselves!
If you have trouble with some kanji, then jisho.org is a really good source. I mean. I only took Japanese one year in HS so it is not the best, but with jisho most things can be somewhat understood. I mean, I suck at kanji so XD
The example page would be something like:
"出たあああ！！！" ("It appeared!/It came out!" Often used for ghosts or monsters appearing, lol)
"ガタァ" (probably clattering from the chairs)
"うわああああああ" ("Uwaaaaa" screaming)
"妖怪カンファ荒らしだああ！！！" (maybe something about "the demon/ghost has come to wreck our conference/meeting"? No clue honestly. Altho I think it is super funny that they literally call him a ghost o a demon XD)
@gentay That was an interesting read. I didn't expect to learn something new from thos comment section, but I did. 🙂
I mean, unless the mangaka consults a professional, or is a professional themselves, it would be hard to get all of that. Plus it wouldn't make for good drama, probably....
Member
- Joined
- Mar 8, 2019
- Messages
- 221
Thank you so much for the hard work on this chapter! It was a great read!
@gentay Thank you so much for taking the time to write a very detailed explanation!! It was really interesting to read it. My opinion on the matter of subject accuracy is that it's less a concern to editors/publishers compared to drama in the plot. Also, not all artists can consult with an actual professional on the subject matter of their story. It's a little complicated, and also depends on how much research time the artist has till the next deadline, how many resources he/she can obtain (might also relate to how famous he/she is in the industry.) It's really hard to say.
In the end, it really comes down to what intent does the creator has for his/her story.
@gentay Thank you so much for taking the time to write a very detailed explanation!! It was really interesting to read it. My opinion on the matter of subject accuracy is that it's less a concern to editors/publishers compared to drama in the plot. Also, not all artists can consult with an actual professional on the subject matter of their story. It's a little complicated, and also depends on how much research time the artist has till the next deadline, how many resources he/she can obtain (might also relate to how famous he/she is in the industry.) It's really hard to say.
In the end, it really comes down to what intent does the creator has for his/her story.
