An Adolescent with dizziness and near syncope
Submitted by Maura Corbett, PA-C, written by Alex Bracey, with some comments by Smith and MeyersA teenage male presented to the emergency department with the complaint of dizziness with near-syncope. He was stable and able to provide a history and mentioned that he was asymptomatic while seated but dizzy and weak when attempting to stand. An ECG was recorded:What do you think? There iscomplete (third degree) heart block with wide complex bradycardicescape. The morphology is that of LBBB and so the escape is originating from the right bundle.The possible etiologies of this ECG are:- Structural/congenital heart di...
Source: Dr. Smith's ECG Blog - August 7, 2021 Category: Cardiology Authors: Bracey Source Type: blogs
Treatment of infective endocarditis
Discussion of whole list of options of antimicrobials for different varieties of endocarditis is quite a large topic. This discussion is only a broad outline of the antimicrobial treatment of infective endocarditis, meant mainly for exam purpose rather than actual clinical treatment. References to more detailed guidelines have been provided for those who wish to learn more.
Inoculum Effect
High microbial density as in vegetations cause less antimicrobial activity of some antimicrobial agents. This is known as inoculum effect and has been documented with β-lactams and glycopeptides but not linezolid, in the treatment of St...
Source: Cardiophile MD - July 16, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
Sunday Sermonette: Icky stuff
Leviticus 15 is another one of those chapters that fundamentalists pretend doesn ' t exist. We get that the priestly rituals detailed in Leviticus ended with the destruction of the second temple. Rather odd, if they were so important to God, that he lost interest at that point. (We ' ll get to more on that next week.) But at least it ' s proffered as an explanation. Nothing happened to cancel this out, however. The part at the end about menstruation orthodox Jews still pay partial attention to.15 TheLord said to Moses and Aaron,2 “Say to the people of Israel, When any man has a discharge from his body, his disc...
Source: Stayin' Alive - May 17, 2020 Category: American Health Source Type: blogs
Teenager with chest pain and slightly elevated troponin. What happens then?
This is a previously healthy male teenager who was awoken by chest pain. He was seen at another hospital and found to have a slightly elevated troponin, then underwent a CT pulmonary angiogram (PE) protocol which revealed a right sided pneumonia. He was treated with Ceftriaxone and azithromycin.p.p1 {margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Calibri; background-color: #fefefe}The pain is described as located in the midsternal area, radiating to the right arm, described as 8-9/10 and worse with deep inspirations. He endorsed cough, fever, and body aches in the previous day...
Source: Dr. Smith's ECG Blog - December 9, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs
The antibiotics arms race must end
“Cha-ching!” goes urgent care. For your rhinovirus, adenovirus, or seasonal allergies you get a strep screen, flu swab, CBC, and chest X-ray. You get a steroid shot, Rocephin, and Z-Pak. A week later, you present for medical care again, because your virus is no better, and you want a stronger an tibiotic. In the meantime, your […]Find jobs at Careers by KevinMD.com. Search thousands of physician, PA, NP, and CRNA jobs now. Learn more. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - January 18, 2019 Category: General Medicine Authors: < span itemprop="author" > < a href="https://www.kevinmd.com/blog/post-author/charles-w-olson-jr" rel="tag" > Charles W. Olson, Jr., MD < /a > < /span > Tags: Conditions Infectious Disease Source Type: blogs
Distinguishing between Orbital and Preseptal Cellulitis
Some medical conditions have signs and symptoms that significantly overlap, making a diagnosis a little more difficult. Epididymitis, testicular torsion, and torsion of the testicular appendage are examples, but orbital and preseptal cellulitis are others that can cause significant diagnostic confusion.Both conditions are more common in children than in adults, and preseptal or periorbital cellulitis is more common in children under 5. The preseptal and orbital spaces are separated by only a thin membranous septum that originates in the orbital periosteum and inserts into the tarsal plates. It is only this thin septum t...
Source: M2E Too! Mellick's Multimedia EduBlog - December 31, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Tropical Travel Trouble 004 Bloody Diarrhoea
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog
aka Tropical Travel Trouble 004
A medical student who has just returned from their elective in Nepal presents with 1 week of bloody diarrhoea. He has been in the lowlands and stayed with a family in the local village he was helping at. It started three days before he left and he decided to get home on the plane in the hope it would settle. He is now opening his bowels 10x a day with associated cramps, fevers and has started feeling dizzy.
Questions:
Q1. What is dysentery ...
Source: Life in the Fast Lane - March 12, 2018 Category: Emergency Medicine Authors: Neil Long Tags: Clinical Cases Tropical Medicine amoebic dysentery bacillary dysentery e.histolytica entamoeba histolytica shigellosis Source Type: blogs
MKSAP: 46-year-old man with fever, dysuria, and urinary frequency
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 46-year-old man is evaluated for fever, dysuria, and urinary frequency of 1 day’s duration. He also notes a sensation of deep pelvic pain near the rectum. He has no urethral discharge or testicular pain. He states that he felt well before the current illness and has no other symptoms. Medical history is unremarkable. He is not sexually active. He takes no medications.
On physical examination, temperature is 38.8 °C (101.8 °F), blood pressure is 130/80 mm Hg, pulse rate is 100/min, and respiration rate ...
Source: Kevin, M.D. - Medical Weblog - September 9, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Infectious Disease Primary Care Urology Source Type: blogs
Antimicrobial Resistance: Where to from Here?
Conclusion
Newer tools capable of informing these early decisions are under development, but integrating an awareness of AMR into both hospital and GP practice is a key component of winning the fight against superbugs. Throughout the development process, discussion between clinicians and researchers will ensure that diagnostic tools are effective, and also meet the needs of frontline staff.
In the mean-time, cultivating an AMR aware mind-set is the best defence against over-prescription. Understanding and accepting the systematic, ubiquitous biases which affect our judgement of risk is particularly helpful. For example, do...
Source: Life in the Fast Lane - May 16, 2017 Category: Emergency Medicine Authors: Jarrad Hall Tags: Clinical Research Microbiology AMR Antimicrobial resistance ESBL MROs multi-resistant organisms multidrug resistant organisms (MROs) Source Type: blogs
Antimicrobial Resistance: Where to from Here?
Conclusion
Newer tools capable of informing these early decisions are under development, but integrating an awareness of AMR into both hospital and GP practice is a key component of winning the fight against superbugs. Throughout the development process, discussion between clinicians and researchers will ensure that diagnostic tools are effective, and also meet the needs of frontline staff.
In the mean-time, cultivating an AMR aware mind-set is the best defence against over-prescription. Understanding and accepting the systematic, ubiquitous biases which affect our judgement of risk is particularly helpful. For example, do...
Source: Life in the Fast Lane - May 16, 2017 Category: Emergency Medicine Authors: Jarrad Hall Tags: Clinical Research Microbiology AMR Antimicrobial resistance ESBL Joanna Tedeschi MROs multi-resistant organisms multidrug resistant organisms (MROs) Source Type: blogs
MKSAP: 30-year-old woman with right antecubital fossa and biceps pain
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 30-year-old woman is evaluated for a 2-day history of increasing pain in the right antecubital fossa and biceps. She reports daily injection drug use. Medical history is otherwise unremarkable, and she takes no prescription medications.
On physical examination, temperature is 39.7 °C (103.5 °F), blood pressure is 90/56 mm Hg, pulse rate is 120/min, and respiration rate is 28/min. BMI is 28. She appears ill. No lymphangitis or right axillary or epitrochlear lymphadenopathy is evident. The right biceps area i...
Source: Kevin, M.D. - Medical Weblog - April 9, 2016 Category: Journals (General) Authors: mksap Tags: Conditions Infectious disease Source Type: blogs
Zen and the Art of Antibiotics
By HANS DUVEFELT, MD Jacques Johndreau did not look like his usual self when I saw him in the office a few weeks ago. He looked part retired bank manager and part Disney cartoon chipmunk. He spoke with hardly any facial movements: “Holy Boys, my wife said to me this morning, you look like you’ve got […] (Source: The Health Care Blog)
Source: The Health Care Blog - December 29, 2014 Category: Consumer Health News Tags: Uncategorized antibiotics Ceftriaxone Clindamycin Source Type: blogs
Research and Reviews in the Fastlane 054
Conclusions Wrong? (emlitofnote)
Critical Care, CardiologyGuyton AC. Regulation of cardiac output. Anesthesiology. 1968; 29(2): 314-26. PMID: 5635884
The modern emphasis on echo might make you think that the heart determines cardiac output. This classic paper by Guyton shows that unless the heart is failing, it has a permissive role in determining cardiac output. The real determinants are (1) the degree of vasodilation of the peripheral vasculature, especially veins, and (2) the filling of the circulatory system, indicated by the mean systemic filling pressure. Gotta love those Guyton curves!
Recommended by: Chris Nick...
Source: Life in the Fast Lane - October 20, 2014 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Cardiology Clinical Research Education Emergency Medicine Infectious Disease Intensive Care Neurology Neurosurgery Obstetrics / Gynecology Orthopedics Pediatrics Trauma critical care literature R&R in the FASTLANE recommendat Source Type: blogs
MKSAP: 72-year-old unconscious woman in the ER
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 72-year-old woman is evaluated in the emergency department for loss of consciousness. Her son, who brought her in, says she seemed confused and agitated when he spoke to her on the telephone less than 2 hours ago. The patient has an 8-year history of type 2 diabetes mellitus. She had strict glycemic control (average hemoglobin HbA1c level, 6.2%) until last month when she had an infected ulcer between the third and fourth toes of the right foot that resulted in amputation of the middle toe 1 week ago. According...
Source: Kevin, M.D. - Medical Weblog - September 20, 2014 Category: Journals (General) Authors: mksap Tags: Conditions Diabetes Emergency Endocrinology Source Type: blogs
Long QT: Do not trust the computerized QT interval when the QT is long
A middle-aged male with h/o DM was found down. He was hypoglycemic (mild, 45 mg/dl) and had pneumonia with hypoxia. He had this ECG recorded:Sinus rhythm with slight right axis deviation and non-diagnostic T-wave inversionsHe received azithromycin and ceftriaxone for community acquired pneumonia. Then he became very agitated in spite of correction of hypoglycemia, and was given a total of 15 mg of haloperidol. His K returned at 2.8 mEq/L and ionized Calcium at 3.82 mEq/L (normal, 4.4 -5.2). Magnesium was 1.5 mEq/L (normal, 1.3 - 2.0)A troponin returned slightly elevated, so another ECG was rec...
Source: Dr. Smith's ECG Blog - June 3, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs
