MKSAP: 46-year-old woman is evaluated before a dental cleaning
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 46-year-old woman is evaluated before undergoing a dental cleaning procedure involving deep scaling. She has a history of mitral valve prolapse without regurgitation and also had methicillin-resistant Staphylococcus aureus (MRSA) aortic valve endocarditis 10 years ago treated successfully with antibiotics. The patient notes an allergy to penicillin characterized by hypotension, hives, and wheezing. The remainder of the history is noncontributory.
On physical examination, vital signs are normal. Cardiopulmonar...
Source: Kevin, M.D. - Medical Weblog - April 18, 2015 Category: Journals (General) Authors: mksap Tags: Conditions Infectious disease Source Type: blogs
Research and Reviews in the Fastlane 078
Welcome to the 78th edition of Research and Reviews in the Fastlane. R&R in the Fastlane is a free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature.This edition contains 7 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Anand Swaminathan and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&...
Source: Life in the Fast Lane - April 9, 2015 Category: Emergency Medicine Authors: Anand Swaminathan Tags: LITFL R&R in the FASTLANE critical care Emergency Medicine recommendations research and reviews Source Type: blogs
Antibiotic resistance – should we blame primary care or ICU physicians?
The title of the post poses a somewhat silly question. But I hope my explication clarifies the point.
Many readers know that I favor empiric antibiotic treatment for adolescent/young adult pharyngitis when the clinical signs and symptoms strongly suggest a bacterial infection. I favor narrow target antibiotics and only in the patients with Centor scores of 3 or 4 (and perhaps some 2s when the patient looks very ill). This would exclude over 50% of patients from antibiotics.
Most organisms already have developed resistance to penicillin, amoxicillin and first generation cephalosporins. Macrolides should not be used for ...
Source: DB's Medical Rants - March 3, 2015 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Interpreting the new sore throat article
First, this study required the work of a large team. The main work happened in two places – a research microbiology laboratory and our college health clinic. They took an idea and translated it into an opportunity to collect and analyze data.
Second, the accompanying editorial (written by a friend and excellent researcher Dr. Jeffrey Linder) raises some questions that I will work to answer. He writes that we do not have enough evidence to change practice yet. He postulates that Fusobacterium necrophorum might not actually cause pharyngitis and that linking positive PCR testing to the risk of suppurative complicat...
Source: DB's Medical Rants - February 23, 2015 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Research and Reviews in the Fastlane 070
This study demonstrated a high sensitivity (86%) and very high specificity (97%) when looking for consolidations > 1 cm on US compared to chest X-ray as the standard. The study was done quickly (mean 7 minutes) and by non-experts (1 hour of training) increasing the likelihood that the findings can be generalized to non-study settings.Recommended by: Anand SwaminathanThe Best of the RestResuscitationOlaussen A, et al. Return of consciousness during ongoing Cardiopulmonary Resuscitation: A systematic review, Resuscitation 2014; 86: 44-48. PMID 25447435After introduction of mechanical CPR device CPR induced consciousnes...
Source: Life in the Fast Lane - February 11, 2015 Category: Emergency Medicine Authors: Soren Rudolph Tags: Education Emergency Medicine Neurosurgery Pediatrics Resuscitation Trauma critical care examination Intensive Care R&R in the FASTLANE research and reviews Source Type: blogs
How Can You Be Sure?
“How can you be sure?”
That question stopped our discussion for a second.
During some down time, several nurses and I were talking about childhood coughs. Her 6 month old child had just started daycare 2 weeks ago and has been coughing ever since. The child was put on amoxicillin and then Zithromax by her pediatrician but … [GASP] … her cough wasn’t getting any better. The nurse thought her child had pneumonia.
“What should she be taking now?”
I was in a particularly snarky mood, so, with a smirk, I said “probably vancomycin … maybe add gentamycin just for the gram nega...
Source: WhiteCoat's Call Room - January 13, 2015 Category: Emergency Medicine Authors: WhiteCoat Tags: Random Thoughts Source Type: blogs
MKSAP: 46-year-old woman undergoing a dental cleaning
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 46-year-old woman is evaluated before undergoing a dental cleaning procedure involving deep scaling. She has a history of mitral valve prolapse without regurgitation and also had methicillin-resistant Staphylococcus aureus(MRSA) aortic valve endocarditis 10 years ago treated successfully with antibiotics. The patient notes an allergy to penicillin characterized by hypotension, hives, and wheezing. The remainder of the history is noncontributory.
On physical examination, vital signs are normal. Cardiopulmonary...
Source: Kevin, M.D. - Medical Weblog - January 10, 2015 Category: Journals (General) Authors: mksap Tags: Conditions Heart Infectious disease Source Type: blogs
Sudden death and a common antibiotic
The longer I practice medicine, the more nervous I get about medications, especially when patients are already on other drugs for chronic diseases. I much prefer deprescribing.
A recent study on the common antibiotic cotrimoxazole, which is a combination of sulfamethoxazole and trimethoprim, and often referred to by its brand name, Bactrim or Septra, lends credence to the notion that combining drugs can be dangerous.
In a large case control study of more than 1.6 million patients over 17 years, researchers from Canada found that cotrimoxazole was associated with a three-fold increased risk of sudden death when used in olde...
Source: Dr John M - November 12, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
MKSAP: 32-year-old man with cough and nasal congestion
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 32-year-old man is evaluated for a 3-day history of productive cough, sore throat, coryza, rhinorrhea, nasal congestion, generalized myalgia, and fatigue. His sputum is slightly yellow. His two children (ages 3 years and 1 year) had similar symptoms 1 week ago. He is a nonsmoker and has no history of asthma.
On physical examination, temperature is 37.5 °C (99.4 °F), blood pressure is 128/76 mm Hg, pulse rate is 92/min, and respiration rate is 14/min. There is bilateral conjunctival injection. The nasal mucos...
Source: Kevin, M.D. - Medical Weblog - September 14, 2014 Category: Journals (General) Authors: mksap Tags: Conditions Primary care Source Type: blogs
Did chemotherapy change your body?
A week or so ago, I had asked a doctor about change in your body due to chemotherapy. A friend and I had the same discussion yesterday. Does chemotherapy change a person's body in more ways than we think?I am talking about food and medications to be specific.Before chemotherapy, I enjoyed all kinds of seafood - preferably cold ocean water seafood to be precise. Shrimp, lobster, clams, oysters, scallops, cod, haddock, hake, salmon, calamari (octopus), and more. I never turned it down. Now I hate shrimp. I won't eat them. I can't stand them.More importantly are medical allergies. Before chemo, I was told I was allergic to am...
Source: Caroline's Breast Cancer Blog - July 26, 2014 Category: Cancer Tags: allergens changes chemotherapy reactions Source Type: blogs
Bad medical care: Is it better than none at all?
In my past few shifts in the emergency department, I have seen the following patients who were seeking further care after being treated by other providers.
One was a child who had been seen twice at an urgent care clinic. He had a fever of 103 degrees and wasn’t eating. The first time he went to the urgent care center, he was diagnosed with an ear infection. He was started on amoxicillin and sent home. He returned to the clinic 8 hours later because he still had the fever and still wasn’t eating. When the clinic provider looked in his mouth, he saw a red rash that appeared to be an allergic reaction. He was therefore c...
Source: Kevin, M.D. - Medical Weblog - July 21, 2014 Category: Journals (General) Authors: WhiteCoat, MD Tags: Physician Emergency Source Type: blogs
Limitations of e-Prescribing Standards
The following is an important guest post from Dr. Marvin Harper, CMIO at Boston Children's Hospital, identifying a gap in e-prescribing standards:Why am I guest writing a blog post here? As a practicing pediatrician and CMIO at Boston Children’s Hospital I am particularly sensitive to specific limitations of current e-prescribing standards.Being able to write and route prescriptions electronically provides many advantages over the handwritten paper prescription process that inherently uses families as couriers. Nonetheless the current standards for e-prescribing have created a void that permits limitations i...
Source: Life as a Healthcare CIO - July 21, 2014 Category: Technology Consultants Source Type: blogs
Stop Expecting Antibiotics to Be Handed Out Routinely: Here’s Why
For years, my colleagues on the Prepared Patient site have preached the importance of being an advocate for your own care. And they’ve noted that at times it is necessary to push back against doctors’ recommendations if a suggested treatment does not seem right. I just returned from a visit to the U.K., which drove home the importance of that advice. Coming down with a common cold gave me a chance to experience differences in how British and American doctors approach the nasty symptoms of an all-too-common medical problem.
Let’s face it. Most of us have been given too many antibiotics for sore throats, co...
Source: Disruptive Women in Health Care - June 16, 2014 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Access Consumer Health Care Policy Source Type: blogs
UPDATED Feb. 27: All You Ever Wanted to Know about Group A Streptococcal Pharyngitis But Were Afraid to Ask
Why I Disagree with the IDSA Guidelines for GAS in Children Under 3
IDSA Statement: Diagnostic studies for GAS pharyngitis are not indicated for children under age 3 because acute rheumatic fever is rare in children under 3 and the incidence of streptococcal pharyngitis and the classic presentation of streptococcal pharyngitis are uncommon in this age group [emphasis added]. Selected children under 3 who have other risk factors, such as an older sibling with GAS infection, may be considered for testing (strong, moderate).
The prevalence of GAS pharyngitis is significantly lower for children under 3; it ranges from 10...
Source: M2E Too! Mellick's Multimedia EduBlog - January 31, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
UPDATED Feb. 27: All You Ever Wanted to Know about Group A Streptococcal Pharyngitis But Were Afraid to Ask
Why I Disagree with the IDSA Guidelines for GAS in Children Under 3
IDSA Statement: Diagnostic studies for GAS pharyngitis are not indicated for children under age 3 because acute rheumatic fever is rare in children under 3 and the incidence of streptococcal pharyngitis and the classic presentation of streptococcal pharyngitis are uncommon in this age group [emphasis added]. Selected children under 3 who have other risk factors, such as an older sibling with GAS infection, may be considered for testing (strong, moderate).
The prevalence of GAS pharyngitis is significantly lower for children under 3; it ranges fro...
Source: M2E Too! Mellick's Multimedia EduBlog - January 31, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
