Ride the Fluid Wave Before Performing a Paracentesis
Before you break out the bottles for a paracentesis, you may want to consider doing a test for ascites. Many procedures require executing an old-school test before even looking at a result or grabbing an ultrasound machine. Knowing what to look for on a physical exam may guide your practice and intervention dramatically. Using noninvasive tools first could help your patient avoid other tedious or unnecessary testing, which may also result in lost time. Incorporating ultrasound into your practice may also help you nail a diagnosis or allow you to perform a procedure better than you expected.A markedly distended abdomen due to ascites. The abdominal cavity may contain many liters of fluid.Laying your hands on a patient's abdomen is still one of the best ways to help make an accurate diagnosis. This is true of such tests as deep pressure applied to the right lower quadrant to help rule out an appendicitis, which is about 91% sensitive (Shackelford's Surgery of the Alimentary Tract, Eighth Ed. Philadelphia: Elsevier; 2019), or deeply palpating the right upper quadrant to check for cholecystitis, which is about 97% sensitive. (J R Coll Surg Edinb. 1996;41:88.) The fluid wave and fluid thrill tests have been used for years to check for ascites or free fluid in the abdomen. They are our tests of choice to perform before setting up for paracentesis, though a fluid wave is a more specific but less sensitive finding.The Cause of AscitesAscites can be caused by many disease proces...
Atypical chest pain is of diverse origin. Typically, we initially consider cardiac etiology. When pain appears non-cardiac, there is a tendency to underestimate the illness, especially if the patient has neuropsychiatric illness. Our resident with dementia and anxiety disorder had chest pain; the diagnosis was unexpected.
Chronic pain is common among older adults, as is the use of medications to treat these symptoms. Aging physiology, in combination with a higher likelihood of medication use and declining renal function, makes older adults more susceptible to adverse drug effects. As such, monitoring for side effects and changes in renal function is important to avoid drug toxicity, especially during acute illness when medication errors and acute changes in renal function are more likely to occur among older adults.
Many patients are discharged to post-acute care facilities (PACFs) following surgery. These patients have either had major surgery and require close monitoring and intensive rehabilitation, or have significant medical co-morbidities. Currently they are transported, sometimes at considerable cost, to the surgeon ’s office for post-surgery visits (PSVs). These trips can be painful and uncomfortable. A staff member from the PACF may need to accompany the patient. During PSVs surgeons observe the patient's incision(s), and assess potential complications following surgery, pain, and functional recovery.
Heart failure (HF) is a leading cause of mortality and hospital readmissions in the United States. A large proportion of these patients are readmitted from skilled nursing facilities (SNF). The implementation of quality initiatives, such as staff education, to recognize early measures of clinical instability could improve HF management at these facilities.
Chronic pain is among the most common reasons for seeking medical attention. In the United States, 1 in 5 adults had chronic pain in 2016 and it is estimated to cost over $500 billion annually in direct medical costs and disability. It is a prevalent problem among residents in the nursing home. Non-pharmacologic therapies are the most preferred treatment for chronic pain as pharmacological therapies, such as opioids, have proven to be less effective and associated with numerous side effects among older adults.
Authors: Miller A, Cairns A, Richardson A, Lawrence J Abstract CONTEXT: Tuberculosis (TB) is a serious infectious disease with high rates of morbidity and mortality if left untreated. In Australia, TB has been virtually eradicated in non-Indigenous Australian-born populations but in remote Aboriginal and/or Torres Strait Islander communities TB presents a rare but significant public health issue. Remote health services are most likely to encounter patients with suspected and confirmed TB diagnosis but may be unprepared for supporting someone with this disease and the complexities of balancing public health risk wit...
Hi guys, I'm trying to gauge where I stand and am very confused due to my weird background. I took the MCAT in Jan and received a 524, but my GPAs are on the lower end. I am AA URM. GPA: 3.66c, 3.73s, 1 year 4.0 at end || 3.5 masters, 3.5 PhD first year (left see below) MCAT: 524 || Balanced, first take State: CA Race: URM, AA Clinical Volunteering: 250 hours - general hospital volunteer pulm unit 200 hours - driver for american cancer society patients 280... 3.66 cGPA, 3.73sGPA, 524 MCAT URM
Publication date: Available online 25 February 2020Source: The Lancet Respiratory MedicineAuthor(s): Tony Kirby
Publication date: Available online 26 February 2020Source: NeuroImage: ClinicalAuthor(s): J.A. Kim, R.B. Bosma, K.S. Hemington, A. Rogachov, N.R. Osborne, J.C. Cheng, J. Oh, B.T. Dunkley, K.D. Davis