Two Patients With More Than One Diagnosis
BY HANS DUVEFELT
I have written many times about how I have made a better diagnosis than the doctor who saw my patient in the emergency room. That doesn’t mean I’m smarter or even that I have a better batting average. I don’t know how often it is the other way around, but I do know that sometimes I’m wrong about what causes my patient’s symptoms.
We all work under certain pressures, from overbooked clinic schedules to overfilled emergency room waiting areas, from “poor historians” (patients who can’t describe their symptoms or their timeline very well) to our own mental fatigue after many hours on the...
Source: The Health Care Blog - March 16, 2023 Category: Consumer Health News Authors: Ryan Bose-Roy Tags: Medical Practice Hans Duvefelt neuralgia sinusitis Source Type: blogs
A Man With Sudden Onset of Gastroparesis
By HANS DUVEFELT
Leo Dufour is not a diabetic. He is in his mid 50s, a light smoker with hypertension and a known hiatal hernia. He has had occasional heartburn and has taken famotidine for a few years along with his blood pressure and cholesterol pills.
Over the past few months, he started to experience a lot more heartburn, belching and bloating. Adding pantoprazole did nothing for him. I referred him to a local surgeon who did an upper endoscopy. This did not reveal much, except some retained food in his stomach. A gastric emptying study showed severe gastroparesis.
The surgeon offered him a trial of metoclopra...
Source: The Health Care Blog - September 16, 2021 Category: Consumer Health News Authors: Christina Liu Tags: Medical Practice Physicians Primary Care Hans Duvefelt Source Type: blogs
Olanzapine FTW for Nausea Outside of CINV
by Drew Rosielle (@drosielle)A few months agoan interesting olanzapine study was published which I have been meaning to write a post about. It ' s important because while olanzapine has really established itself in the last decade as a highly effective antiemetic for chemotherapy induced nausea and vomiting, and is now in multiple CINV guidelines (eg Antiemetics: ASCO Guideline), etc, we don ' t have a lot of data for its efficacy for nausea outside of CINV, and so a well-done RCT is welcome.The study is amulti-center, US, adult, randomized, placebo-controlled, double-blind trial of olanzapine for nausea in advanced cancer...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 1, 2021 Category: Palliative Care Tags: anorexia cachexia nausea olanzapine rosielle Source Type: blogs
Functional dyspepsia: Causes, treatments, and new directions
Functional dyspepsia (FD) is a common condition, loosely defined by some physicians as a stomach ache without a clear cause. More specifically, it is characterized by the feeling of fullness during or after a meal, or a burning sensation in the mid-upper abdomen, just below the rib cage (not necessarily associated with meals). The symptoms can be severe enough to interfere with finishing meals or participating in regular daily activities.
Those with FD often go through multiple tests like upper endoscopy, CT scan, and gastric emptying study. But despite often-severe symptoms, no clear cause (such as cancer, ulcer disease, ...
Source: Harvard Health Blog - July 6, 2020 Category: Consumer Health News Authors: Vikram Rangan, MD Tags: Digestive Disorders Mind body medicine Pain Management Source Type: blogs
Research and Reviews in the Fastlane 191
This article has spawned a lot of controversy. It is worth reading to understand why.
Recommended by: Justin Morgenstern
Emergency Medicine
Samuels EA, et al. “Sometimes You Feel Like the Freak Show”: A Qualitative Assessment of Emergency Care Experiences Among Transgender and Gender-Nonconforming Patients. Annals of emergency medicine. 2017. PMID: 28712604
This is a qualitative study of transgender patients who visited an ED in the US. This article is a must read as providers often lack insight into the complexities of caring for transgender patients and systemic barriers to conscientious care. This arti...
Source: Life in the Fast Lane - January 10, 2018 Category: Emergency Medicine Authors: Justin Morgenstern Tags: Emergency Medicine Gastroenterology R&R in the FASTLANE Respiratory Resuscitation EBM Education recommendations research and reviews Source Type: blogs
Funtabulously Frivolous Friday Five 206
LITFL • Life in the Fast Lane Medical Blog
LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog
Just when you thought your brain could unwind on a Friday, you realise that it would rather be challenged with some good old fashioned medical trivia FFFF…introducing Funtabulously Frivolous Friday Five 206.
Question 1
What condition is Ewart on the left, Conner on the right and when those two disappear Bamberger is present?
+ Reveal the Funtabulous Answer
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Pericardi...
Source: Life in the Fast Lane - September 22, 2017 Category: Emergency Medicine Authors: Neil Long Tags: Education akathisia Bamberger's sign Bertolotti's syndrome chlorine urine Conner's sign Ewart's sign gaetan dugas Hawkinsinuria low back pain patient zero Source Type: blogs
Another Case of Vomiting
A 26-year-old man presented to the emergency department with nausea, vomiting, and abdominal pain. He said he had had the pain, which he said encompassed his entire abdomen, for three days.He had been unable to tolerate anything by mouth. His vitals on presentation included a heart rate of 115 bpm, blood pressure of 126/70 mm Hg, respiratory rate of 22 bpm, and pulse oximetry of 100% on room air.Physical examination revealed dry mucus membranes, dry skin, tachycardia without murmurs, and clear lungs. Abdominal examination demonstrates hyperactive bowel sounds without pain on palpation or hepatosplenomegaly. The patie...
Source: The Tox Cave - December 1, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
An open letter to Heather Bresch: What is legal is not always ethical
Dear Ms. Bresch,
I couldn’t help but notice the barrage of negative press you’ve received lately regarding the significant price increases in EpiPens. A 461 percent increase since 2007, to be exact. People who require this medication for themselves or their children are up in arms about spending over $600 for a twin pack of autoinjectors. Most of these people have life-threatening anaphylaxis if they are exposed to certain allergens. To them, whether or not they have an EpiPen could mean life or death.
Now, I don’t want to bore you with the medical stuff. You are not a clinician; you are a business woman. I know you ...
Source: Kevin, M.D. - Medical Weblog - September 3, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/anonymous" rel="tag" > Anonymous < /a > Tags: Meds Medications Source Type: blogs
Research and Reviews in the Fastlane 142
This study demonstrated that very early administration (pre-hospital) did not change outcomes in terms of infarct size. There was also no reduction in ventricular dysrhythmias. Once again we see that earlier is not always better.
Recommended by Anand Swaminathan
The R&R iconoclastic sneak peek icon key
The list of contributors
The R&R ARCHIVE
R&R Hall of famer You simply MUST READ this!
R&R Hot stuff! Everyone’s going to be talking about this
R&R Landmark paper A paper that made a difference
R&R Game Changer? Might change your clinical practice
R&R Eureka! Revolut...
Source: Life in the Fast Lane - July 13, 2016 Category: Emergency Medicine Authors: Jeremy Fried Tags: Cardiology Clinical Research Education Emergency Medicine Pediatrics R&R in the FASTLANE critical care EBM literature recommendations research and reviews Source Type: blogs
Research and Reviews in the Fastlane 130
In this study, valproate was less efficient and requiring more rescue medications compared to Ketorolac and Metoclopramide. It appears that valproate is not as helpful as a rescue medication as previously thought.
Recommended by: Daniel Cabrera
Emergency Medicine, Pre-Hospital/Retrieval
Bhalla MC et al. Simple Triage Algorithm and Rapid Treatment and Sort, Assess, Lifesaving, Interventions, Treatment, and Transportation mass casualty triage methods for sensitivity, specificity, and predictive values. Am J Emerg Med 2015; 33(11): 1687-91. PMID: 26349777
If you haven’t been exposed to mass casualty triage before, ...
Source: Life in the Fast Lane - April 13, 2016 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Airway Emergency Medicine Gastroenterology Intensive Care Pediatrics Pre-hospital / Retrieval EBM Education literature R&R in the FASTLANE recommendations research and reviews Resuscitation Source Type: blogs
T-wave inversion in a young woman with hyperventilation and carpopedal spasm
This case is another good one contributed by Brooks Walsh, with an excellent review.A 24 year-old African-American female presented to the ED with nausea and vomiting for 1 day. She also complained of paresthesias and cramping in her hands and wrists, as well as perioral paresthesias. She had no significant personal or family medical history. Vitals signs and exam were remarkable only for hyperventilation with clear lungs, and bilateral carpopedal spasms.An ECG was obtained to assess the QTc prior to administering ondansetron:A bedside focused echocardiogram did not demonstrate overt septal or concentric hype...
Source: Dr. Smith's ECG Blog - January 13, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs
MKSAP: 60-year-old woman with gastroparesis
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 60-year-old woman is evaluated during a routine follow-up appointment. She has gastroparesis associated with long-standing type 2 diabetes mellitus. Improved blood sugar control and efforts to eat small, frequent meals did not result in symptom improvement. In addition to these interventions, metoclopramide was started 6 months ago, after which her nausea and periodic vomiting resolved. However, she has had some restlessness at night with the urge to repeatedly cross and uncross her legs. Several weeks ago she...
Source: Kevin, M.D. - Medical Weblog - December 5, 2015 Category: Journals (General) Authors: mksap Tags: Conditions Diabetes GI Source Type: blogs
I’m a stickler about words. And here’s why.
It’s metoprolol.
m-e-t-o-p-r-o-l-o-l
The nurse on the other end of the phone sighs as she tolerates my tirade regarding pronunciation. They all know that I am particular about such things. For metoprolol is neither metoclopramide or metolazone, and the difference could be life altering.
Continue reading ...
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 - May 9, 2015 Category: Journals (General) Authors: Jordan Grumet, MD Tags: Physician Hospital Source Type: blogs
Words
It's metoprolol.m-e-t-o-p-r-o-l-o-lThe nurse on the other end of the phone sighs as she tolerates my tirade regarding pronunciation. They all know that I am particular about such things. For metoprolol is neither metoclopramide or metalazone, and the difference could be life altering. I live in a world of words. Trained in a language created to parse pertinent details. Dysarthria or dysphagia? Paroxysmal nocturnal dyspnea, dyspnea on exertion, or orthopnea? Each variant a spectrum of flavor. A morsel chewed, swallowed, and digested into its basic parts to be rattled off in staccato sente...
Source: In My Humble Opinion - April 26, 2015 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
