See Me Now
A young woman with known psychiatric illness and a tendency toward self-injury was sent to the emergency department for medical clearance. She had presented in the past after ingesting objects, so an upright chest and KUB radiograph were obtained.Nothing unusual popped out at first glance, but it was an entirely different story when magnified in a dark room. The sharp square edge extending beyond the vertebral body was impossible to miss. The four holes confirmed she had almost certainly swallowed a razor blade. Inversion made it even easier to see.Identifying the object is only half the battle. What is the next s...
Source: Lions and Tigers and Bears - August 1, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Why medical errors can never be completely eliminated
This article originally appeared in Physician’s Weekly.
Image credit: Shutterstock.com
Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - July 24, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/skeptical-scalpel" rel="tag" > Skeptical Scalpel, MD < /a > Tags: Physician Gastroenterology Surgery Source Type: blogs
MKSAP: 70-year-old man with heartburn
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 70-year-old man is evaluated in follow-up for heartburn of 7 years’ duration. He has frequent nocturnal reflux but has not had odynophagia or dysphagia, and his weight has been stable. He was recently started on once-daily omeprazole with good control of his symptoms. He has a 30-pack-year history of cigarette smoking and continues to smoke.
On physical examination, vital signs are normal; BMI is 29. The remainder of the physical examination is normal.
He is concerned about his long-term heartburn sympto...
Source: Kevin, M.D. - Medical Weblog - July 21, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Gastroenterology Source Type: blogs
Tropical Travel Trouble 009 Humongous HIV Extravaganza
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 009
The diagnosis of HIV is no longer fatal and the term AIDS is becoming less frequent. In many countries, people with HIV are living longer than those with diabetes. This post will hopefully teach the basics of a complex disease and demystify some of the potential diseases you need to consider in those who are severely immunosuppressed. While trying to be comprehensive this post can not be exhaustive (as you can imagine any patient with a low ...
Source: Life in the Fast Lane - July 7, 2018 Category: Emergency Medicine Authors: Amanda McConnell Tags: Clinical Cases Tropical Medicine AIDS art cryptococcoma cryptococcus HIV HIV1 HIV2 PEP PrEP TB toxoplasma tuberculoma Source Type: blogs
Case of the Week 499
Reminder - I am still taking parasite art submissions for Case of the Week 500! I will feature all artwork on my blog, along with the results of the drawing for 3 prizes :)Now for this week ' s case, we have a very interesting submission from Dr. David Peaper. The patient is an elderly woman presenting with hematemesis. She underwent upper endoscopy and biopsies were taken from areas of erosion/inflammation. The biopsies were submitted for comprehensive vial culture, and the following were observed in the MRC-5 shell vials and traditional tube cultures.Identification? (Source: Creepy Dreadful Wonderful Parasites)
Source: Creepy Dreadful Wonderful Parasites - June 25, 2018 Category: Parasitology Source Type: blogs
Am I a doctor or a mother first?
It is a little after 9 a.m. I am about to start the second of a long list of endoscopy cases when my phone rings. I glance briefly at the caller ID to confirm it isn’t my office or the hospital calling about another patient, and am quickly overcome with dread as I see the screen reads, “daycare.”
Intuitively, I know why they are calling. My four-month-old must have a fever. He had received his scheduled vaccines the previous day and had been febrile all evening. In the morning, he seemed his usual self, so my husband and I sent him to daycare, fingers-crossed.
“I am very sorry,” I tell the patient and the circula...
Source: Kevin, M.D. - Medical Weblog - June 21, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/kelly-g-elterman" rel="tag" > Kelly G. Elterman, MD < /a > Tags: Physician Practice Management Surgery Source Type: blogs
Button Battery Update
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog
Button battery ingestion is one of the leading causes of death in paediatric poisoning and this has sharply risen from 2016 despite manufacturing warnings and the addition of tape to cover the negative side (not very useful once you’ve removed that to place it in your device). See Poison.org for more statistics. What makes button battery ingestion more frightening is the fact that the ingestion may go unwitnessed, the child may have vague symptoms like ‘off...
Source: Life in the Fast Lane - June 20, 2018 Category: Emergency Medicine Authors: Neil Long Tags: Toxicology and Toxinology button battery tox library toxicology library Source Type: blogs
MKSAP: 78-year-old man with symptoms of dysphagia
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 78-year-old man is evaluated for symptoms of dysphagia that began 2 weeks ago. When he eats, he starts coughing after the first bite of food and occasionally has nasal regurgitation.
On physical examination, blood pressure is 135/90 mm Hg, pulse rate is 78/min, and respiration rate is 12/min. Left-sided weakness is noted in both extremities, upper greater than lower.
Which of the following is the most appropriate diagnostic test to evaluate this patient’s dysphagia?
A. Barium swallow
B. Esophageal manome...
Source: Kevin, M.D. - Medical Weblog - June 9, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Gastroenterology Otolaryngology Source Type: blogs
Patients know what ’s wrong with the industry more than we do
As a system, we don’t invest as much time in understanding the broader context of the patient in front of us. The before/after factors that we don’t notice have a far-reaching impact on care.
Recently, I shadowed a patient through a day procedure at an endoscopy center from the time that the nurse checked her weight to the time that she was discharged.
Let’s call her Nancy. She was 82 years old and sprightly with silvery hair curled up all over her head. She smiled easily.
Continue reading ...
Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out h...
Source: Kevin, M.D. - Medical Weblog - June 8, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/praveen-suthrum" rel="tag" > Praveen Suthrum < /a > Tags: Tech Oncology/Hematology Public Health & Policy Source Type: blogs
Why some physicians thrive and some struggle to survive
I’m sitting in the waiting area across the endoscopy room of a major hospital. Mindless talk show TV runs in the background. Patients are waiting patiently. They anxiously look up every now and then from their phones towards the reception desk.
It’s a scene I’ve experienced for years while working in health care while waiting for doctors.
But there’s something different in the air now.
Patients, like those around me, will encounter a doctor who’s excited and enthusiastic. But some will meet another who’s dreading her career.
Health care is changing faster than ever before.
It’s jus...
Source: Kevin, M.D. - Medical Weblog - May 15, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/praveen-suthrum" rel="tag" > Praveen Suthrum < /a > Tags: Policy Primary Care Public Health & Source Type: blogs
ADVANTAGE PLUS Pass-Thru Automated Endoscope Reprocessor Cleared in U.S.
MEDIVATORS, a Cantel Medical company, won clearance from the FDA for its ADVANTAGE PLUS Pass-Thru Automated Endoscope Reprocessor. It works with all kinds of clinical scopes, including duodenoscopes, but what’s cool is that it is supposed to be fit into a wall so that anything passing from a “dirty” room to a “clean” room goes through the device.
About five endoscopes can be cleaned in the system per hour and it relies on Cantel’s own RAPICIDE PA Disinfectant.
This avoids many common human errors and will hopefully reduce the chances of infection passing through endoscopes, an issue that...
Source: Medgadget - April 19, 2018 Category: Medical Devices Authors: Editors Tags: GI Public Health Source Type: blogs
Laparoscopy and IVF - before, after or never ?
Before referring a patient for IVF to an IVF clinic, many gynecologists will insist on doing a laparoscopy . They justify this using all kinds of pretexts. saying" We will get a chance to check your pelvis, so we can clip your tubes, if needed, or burn any endometriosis." Their justification is that doing this will improve the patient's chance of getting pregnant with IVF. This is false, but poor patients don't know any better. They feel that if they are going to spend so much money on IVF, they might as well spend a little bit more on the laparoscopy, if this will improve their IVF success rate !Removing small fibroids an...
Source: Dr.Malpani's Blog - April 5, 2018 Category: Reproduction Medicine Tags: diagnostic laparoscopy Endoscopy ivf operative laparoscopy Source Type: blogs
Is surgical training stuck in the past?
When we look back on the last century, the pace and number of advances in our ability to treat disease and injury is truly astonishing. The exponential growth of technology has contributed to this greatly, as we see new advances often come in the form of new technologies. Amazing innovations in the fields of endoscopy, catheterization, robotics, imaging, navigation, 3D printing and more allow us to do things that were previously not believed to be possible. While these advances have opened the door to new life-saving options, we have failed to recognize the complications they have brought with them.
In general, these new t...
Source: Kevin, M.D. - Medical Weblog - April 4, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/justin-barad" rel="tag" > Justin Barad, MD < /a > Tags: Physician Surgery Source Type: blogs
Monarch Robotic Endoscopy for Spotting Small, Deep-Seated Lung Nodules Cleared by FDA
Auris Health, based in Redwood City, California, is showing off its brand new Monarch Platform for robotic, accurate endoscopic navigation through the lungs. The Monarch helps physicians to reach more places within the lungs and find smaller lesions, potentially providing a more accurate diagnosis of the presence of lung cancer. The potential for the technology includes delivery of therapy as well as aiding with diagnosis.
The flexible, motor powered endoscope is controlled by a joystick that anyone with experience playing console video games should be immediately comfortable with. Imagery from previously gathered CT scan...
Source: Medgadget - March 29, 2018 Category: Medical Devices Authors: Editors Tags: Medicine Radiology Thoracic Surgery Source Type: blogs
Tropical Travel Trouble 005 RUQ Pain and Jaundice
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 005
Guest Post: Dr Branden Skarpiak – Global Health Fellow, Department of Emergency Medicine. UT Health San Antonio
A 35 year old male presents to your emergency room for right upper quadrant pain that has gotten worse over the last 2-3 days. He also describes associated nausea, vomiting, and fevers. He denies other abdominal pain, or change in his bowel or bladder habits. His wife notes that he has started to “look more yellow” recent...
Source: Life in the Fast Lane - March 19, 2018 Category: Emergency Medicine Authors: Neil Long Tags: Clinical Cases Tropical Medicine amebic amoeba amoebiasis amoebic dysentery amoebic liver abscess bloody diarrhoea e.dispar e.histolytica entamoeba histolytica Source Type: blogs
