# What's hard about basic science?



## Brandon O (Aug 3, 2015)

What basic science concepts -- e.g. in chemistry, biology, physics -- have you found most important for understanding physiology and medicine? In other words, what principles and mechanisms keep showing up at the core of clinical topics? And which have you found most challenging or confusing to grasp? Tonicity? Diffusion? Or what?

This applies to recent/current students, old timers, those with or without extensive pre-clinical science training, and to educators as well. Very interested to hear your experiences.


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## Flying (Aug 3, 2015)

Two things:
Understanding the mechanisms of chemical equilibrium will allow one to "see" the matter of the body and makes similar concepts (resonance, diffusion, acid/base/buffer systems) seem intuitive.
The utility of black-box modeling is obvious in how it has been used to teach so many subjects outside of electrical engineering.


I spent the time studying maths when all the other kids were studying the life sciences. Now that I'm playing catch-up, these two  concepts have stood out the most to me.


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## mgr22 (Aug 3, 2015)

Gravity, momentum, unstable equilibrium.


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## Summit (Aug 3, 2015)

thats a long list


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## khaysley (Aug 3, 2015)

So far the only thing that I have had problems with remembering is the scientific names of all body parts.


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## Ewok Jerky (Aug 3, 2015)

Acid/base. Not disorders, been the actual hydrogen ion thing.


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## Brandon O (Aug 3, 2015)

Flying said:


> Two things:
> Understanding the mechanisms of chemical equilibrium will allow one to "see" the matter of the body



Which mechanisms do you mean?



mgr22 said:


> Gravity, momentum, unstable equilibrium.



Gravity and momentum? What do these help you with in medicine?


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## Ewok Jerky (Aug 3, 2015)

Hip fractures.


Brandon O said:


> Gravity and momentum? What do these help you with in medicine?


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## Flying (Aug 3, 2015)

Brandon O said:


> Which mechanisms do you mean?


Poor word choice on my part. Better to say a strong foundation in Gen. Chemistry, particularly in understanding LaChatlier's and the Electron Cloud model, goes a long way.


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## Brandon O (Aug 4, 2015)

Flying said:


> Poor word choice on my part. Better to say a strong foundation in Gen. Chemistry, particularly in understanding LaChatlier's and the Electron Cloud model, goes a long way.



I can certainly see Le Chatelier's. With respect to electrons, do you mainly mean to help understand the balancing and origin of charges?


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## mgr22 (Aug 4, 2015)

Brandon O said:


> Which mechanisms do you mean?
> 
> 
> 
> Gravity and momentum? What do these help you with in medicine?



Gravity: Circulation, MOI, transport.
Momentum: MOI.


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## Flying (Aug 5, 2015)

Brandon O said:


> I can certainly see Le Chatelier's. With respect to electrons, do you mainly mean to help understand the balancing and origin of charges?


Charges, resonance, stereochemistry. Understanding that electrons are pissy little things constrained by momentum and being able to approximate their behavior (or location) seems to be the foundation of organic chemistry . Although admittedly that's less relevant to physiology/medicine than say, balancing ionic charges.


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## Aprz (Aug 5, 2015)

In regard to assessment and treatment, I don't feel like science helps a lot. I kinda feel like knowing the science behind medicine are just fun facts.

Understanding chemical nomenclature is fun such as

1 = Meth-
2 = Eth-
3 = Prop-
4 = But-
5 = Pent-
6 = Hex-
7 = Hept-
8 = Oct-
9 = Non-
10 = Dec-

An alkane is carbons (C) fully saturated with hydrogrens (H). C(x)H(x+2)






Image taken from here.

Methane (CH4), ONE carbon (meth-)
Ethane (C2H6), TWO carbons (eth-)
Propane (C3H8), THREE carbons (prop-)
Butane (C4H10), FOUR carbons (but-)
Pent-
Hex-
Hept-
Oct-
Non-
Dec-

-ol is an alcohol. Replace _something_ with a hydroxyl group (-OH).

Ethane is C2H6. Ethanol (EtOH) is C2H6O or C2H5OH. Replace a solo hydrogen with a hydroxyl.

Nitroglycerin (NTG in the United States) = Glyceryl Trinitrate (GTN outside of the United States).

Glycerol = Propanol-1,2,3

Recall that Propane is C3H8. Propanol-1,2,3 is replace the 1st, 2nd, and 3rd solo hydrogens with hydroxyl. That would make it C3H8O3.





Image taken from here.

Tri- is also three. Nitrate (NO3) is a nitrogen with three oxygen atoms. For glyceryl trinitrate, replace the three hydroxyls (-OH) with nitrates (NO3). That would make it C3H5N3O9.





Image taken from here. Found via Google.

I personally visualize nitroglycerin the way it is on Wikipedia, but I felt that would be more confusing for you guys. They don't draw lines for the hydrogens and the points/bends are carbons.

Chemical nomenclature is also useful for remembering the catecholamines: dopamine, norepinephrine, and epinephrine.

Catechol = C6H4OHOH





Image taken from here.

-amine = NH2

So a catecholamine is probably gonna have catechol and an amine. Remember that dopamine, norepinephrine, and epinephrine are catecholamines.

Dopamine is the most basic.





Image taken from Wikipedia.

Note: It is not drawing out the hydogens (H), but they are there. The carbons are where the point/bends are.

Norepinephrine is the second most basic. Just add a hydroxyl (-OH) to dopamine. Nor- for normal.





Image taken from Wikipedia.

Epinephrine is the most complex. Add a methyl (CH3) to norepinephrine.





Image taken from Wikipedia.

You can actually apply this to a lot of stuff, but I don't find it particularly useful more than figuring out what kinda of tattoos people have.

Although I learned the concept of diffusion (going from an area of high concentration to low concentration, active versus passive transport) and pressures in high school chemistry (the highest level chemistry I have learned, I have not taken a college level course), I was pretty mind blown how important these were for our body eg the exchange of oxygen and carbon dioxide at the aveoli, movement of ions in the depolarization-repolarization cycle.

I dunno... I don't feel like much of it is useful. They are just fun facts. I feel like I get more bang for my bucks outta learning algorithms, but use some sound judgement when applying those algorithms eg ACLS tachycardia algorithm & sepsis. Don't cardiovert somebody who is tachycardic and in septic shock, lol.


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## Gurby (Aug 5, 2015)

I think a lot of light bulbs turned on for me after we covered the immune and endocrine systems  in my biology class.  I didn't really understand what inflammation/sepsis were until I spent some time learning about mast cells, histamine, etc.  My understanding of sepsis after finishing medic school was pretty much "they're sick... but everywhere..." and I couldn't have told you what histamine does.

I remember not understanding how ARDS is so dangerous, and not really understanding what "inflammation of the lungs" could mean.


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## Brandon O (Aug 5, 2015)

Thanks guys.

I'm working on a textbook (small) for students in EMS, or similar allied health programs, who need a primer in the sciences and didn't necessarily get it as prerequisites. I don't think this is necessarily dumbing it down as I tend to feel that the high-yield concepts are relatively few (i.e. you don't need the whole chem text, just the first couple chapters). Trying to nail down what exactly would be most important to include.


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## Carlos Danger (Aug 5, 2015)

Brandon O said:


> Thanks guys.
> 
> I'm working on a textbook (small) for students in EMS, or similar allied health programs, who need a primer in the sciences and didn't necessarily get it as prerequisites. I don't think this is necessarily dumbing it down as I tend to feel that the high-yield concepts are relatively few (i.e. you don't need the whole chem text, just the first couple chapters). Trying to nail down what exactly would be most important to include.



I think that is a great idea, Brandon.

There is a text called "Chemistry and Physics for Nurse Anesthesia" that provides a concise review and summary of all the basic sciences and explanations of how the concepts are related to the clinical setting and anesthesia in particular. I can't say I used it a lot, but when I did I found it really useful.

Seeing a similar text geared towards paramedics would be excellent.


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## Brandon O (Aug 5, 2015)

Thanks. The idea was inspired by an old layperson's physics text.

At the end of the day I find that most of the sciences are extremely low yield as far as the understanding they lend to physiology and everyday clinical medicine, but a handful of principles do show up again and again, and if truly understood can lend great explanatory power. But the key is true understanding, not just being able to do equations or parrot the words.


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## MonkeyArrow (Aug 5, 2015)

Hope I'm not too late to the party but the concept of ligands and protein receptors and how much they have to do with the pharmacology and physiology of most processes we deal with. I don't know if it is necessary hard, but important. Also, cell permeability and the sodium potassium transport pumps and the concept of diffusion (extra and intra cellular balances and movements).


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## ERDoc (Aug 7, 2015)

It's important to remember that what happens at the micro level doesn't necessarily translate to the macro level.  I don't have any good specific examples off of the top of my head but I have heard lots of students from EMS up to MD/DO say things like, "But drug X works on receptor Y so you shouldn't give it during condition Z."  They have a full understanding of the micro but don't realize that chemical reactions in the body don't happen in isolation.  I wish I could remember a specific example that I have come across but the brain is just not clicking today.


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## Brandon O (Aug 7, 2015)

I think this falls under the principle of "there are many things in medicine that make sense but aren't true." And the inverse, of course.

Still helpful to know which things make sense, though.


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## TattooedNay (Aug 7, 2015)

fk you acetylcholine


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## Brandon O (Aug 11, 2015)

Question: any opinions on whether the ideal gas law relationships (PV=nRT and all the subsidiary laws) are high-yield in medicine?

Initially I had thought so, because frankly I find that these relationships come up over and over in life, if you pay attention. But when I sat down to consider, I can't think of many aspects of _physiology_ where they're important. Any votes?


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## Carlos Danger (Aug 11, 2015)

Brandon O said:


> Question: any opinions on whether the ideal gas law relationships (PV=nRT and all the subsidiary laws) are high-yield in medicine?
> 
> Initially I had thought so, because frankly I find that these relationships come up over and over in life, if you pay attention. But when I sat down to consider, I can't think of many aspects of _physiology_ where they're important. Any votes?



I would completely agree with that.


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## Flying (Aug 11, 2015)

The gas laws seem to be the way to go in understanding pulmonary mechanics besides using intuitive explanations (although physical models work well to bridge any gap in understanding).

At the end of the day, we are going to simplify and black-box the clinical picture or physiology in front of us to conform to the way we understand the world.

Whether you use PV=nRT, an alternative explanation, pictures, models, or any combination of those, the student should have the *relationships* down.
99% of students will see a math equation and not realize the equal sign is what makes the equation, not the values one gets out of it.


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## Brandon O (Aug 11, 2015)

I think gas solubility (Henry's law and temp influence) is important in pulmonary physiology, as is an understanding of partial pressures/Dalton's law, but I'm trying to think of an important role for the pressure/volume/temp relationships and I'm not sure it's there.


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## Flying (Aug 11, 2015)

I've only heard the pressure/volume relationship being used to describe basic biomechanics: the diaphragm primer, this is a pneumo, this is PEEP, obstructive airway disease is bad.

You are probably right in that it doesn't yield as much as the other concepts.


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## Brandon O (Aug 30, 2015)

This project has reached the stage of a rough manuscript. Would anybody be willing to give it (or a portion) a quick read and offer their feedback? I'm interested in the perspective of both learners and educators, but most especially the latter who might be recommending a text like this in their classes.

PM or post if you're able to help out.


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## EpiEMS (Aug 30, 2015)

Happy to read through -- if you have a PDF or Word copy, I can throw some comments in.
Might even be worth making a Google Doc...get a bunch of folks on it?


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## Brandon O (Aug 31, 2015)

Not a bad idea for later on... At the moment I'm mostly looking for broader points. I'll shoot you an email.


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