‘To Alcohol! The Cause of, and Solution to, All of Life's Problems’
A 37-year-old woman is brought into the emergency department by EMS after being found down next to a bottle of an unknown substance. (See photo.) Her family said she was initially tearful and repeatedly mumbling, “I’m sorry,” and became progressively less responsive.
She was obtunded and intubated for airway protection upon arrival to the ED. Her initial vital signs were a temperature of 98.8°F, heart rate 110 bpm, blood pressure 187/118 mm Hg, respiratory rate 22 bpm, and pulse oximetry 98% on ventilator. Initial ABG reveals a pH 6.89, pCO2 16, pO2 174, and bicarbonate 3.1. Pertinent lab results include a metabo...
Source: The Tox Cave - August 3, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Dabbling in Dentistry
Most people will experience dental pain or a dental complication at some point in their lives. Dental pain is an incredibly common complaint by people of all ages, especially those who lack dental insurance and suitable hygiene habits. Sometimes, though, poor dentition or injury is simply a result of bad luck. Patients often present to the ED hoping to find a dentist and an answer to their problems.
Your first thought? “I am not a dentist. What am I going to do?” You’re right to an extent. We are not dentists, and often feel we have little to offer patients for acute issues that require equipment we don’t have a...
Source: The Procedural Pause - July 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Dabbling in Dentistry
Most people will experience dental pain or a dental complication at some point in their lives. Dental pain is an incredibly common complaint by people of all ages, especially those who lack dental insurance and suitable hygiene habits. Sometimes, though, poor dentition or injury is simply a result of bad luck. Patients often present to the ED hoping to find a dentist and an answer to their problems.
Your first thought? “I am not a dentist. What am I going to do?” You’re right to an extent. We are not dentists, and often feel we have little to offer patients for acute issues that require equipment we don’t have...
Source: The Procedural Pause - July 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
MKSAP: 25-year-old woman is evaluated for redness at mosquito bite
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 25-year-old woman is evaluated for redness that developed over her right leg at the site of a mosquito bite. She is otherwise healthy and takes no medications.
On physical examination, temperature is 37.2 °C (99.0 °F), blood pressure is 120/70 mm Hg, pulse rate is 70/min, and respiration rate is 14/min. There is an erythematous 3 × 3-cm patch on the right thigh. The area is warm to the touch with no evidence of purulence, fluctuance, crepitus, or lymphadenopathy.
Which of the following is the most appropria...
Source: Kevin, M.D. - Medical Weblog - May 23, 2015 Category: Journals (General) Authors: mksap Tags: Conditions Infectious disease Source Type: blogs
The Lemierre Syndrome – 2014 survey data
Recently, 79 members of Facebook’s Lemierre’s Syndrome Survivor group (which has 813 members) answered a hastily written survey. I wrote this survey to get a rough idea of their experiences. Over the years I have probably talked with at least 10 patients or families about their disease. Two of the discussions occurred after the teenager had died. As I talk with patients or families I have learned much about the devastation that this syndrome causes. This informal survey did not have IRB approval, as it really represents some pilot data and information to inform the struggle to prevent this horrible disease...
Source: DB's Medical Rants - January 20, 2015 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
MKSAP: 74-year-old man with fever and chills
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 74-year-old man is evaluated in the emergency department for a 3-day history of fever and chills as well as confusion. He has a 5-week history of a nonhealing ulcer on the plantar surface of his left foot. He has diabetes mellitus, hypertension, and peripheral vascular disease for which he takes metformin, glyburide, lisinopril, chlorthalidone, and aspirin. He has no known medication allergies.
On physical examination, temperature is 39.0 °C (102.2 °F), blood pressure is 92/60 mm Hg, pulse rate is 108/min, a...
Source: Kevin, M.D. - Medical Weblog - January 17, 2015 Category: Journals (General) Authors: mksap Tags: Conditions Diabetes Infectious disease Source Type: blogs
Ebola Virus Mutates On Entry Into United States. Responds To Antibiotics
Atlanta, GA - The Centers for Disease Control and Prevention (CDC) is reporting two American aid workers who contracted Ebola hemorrhagic fever while treating others in West Africa have started responding to treatment with antibiotics. "Never in my wildest dreams did I imagine Ebola would respond to antibiotics," Dr. Feldor Baldink, a public health physician with the CDC, said in a statement Sunday. Dr. Kent Brantley and Nancy Writebol were flown urgently back to the United States and transferred to Emory University, one of just a handful of American medical centers that are specially equipped to do nothing...
Source: The Happy Hospitalist - August 3, 2014 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous Source Type: blogs
Research and Reviews in the Fastlane 040
In this study the role of a “1/2 dose” thrombolysis was evaluated for the reduction of pulmonary artery pressure in moderate PE. A total of 121 patients with moderate PE received either tissue plasminogen activator plus anticoagulation or anticoagulation alone with the primary end points of pulmonary hypertension and the composite end point of pulmonary hypertension and recurrent PE at 28 months. The results suggested that the ½ dose or “safe dose” thrombolysis was safe and effective in the treatment of moderate PE, with a significant immediate reduction in the pulmonary artery pressure that was ma...
Source: Life in the Fast Lane - July 21, 2014 Category: Emergency Medicine Authors: Soren Rudolph Tags: Anaesthetics Emergency Medicine Evidence Based Medicine Featured Gastroenterology Haematology Health Infectious Disease Intensive Care Neurology Pre-hospital / Retrieval Respiratory critical care literature R&R in the FASTLANE Source Type: blogs
Research and Reviews in the Fastlane 038
This study, however, has major flaws and biases that question the validity of their conclusions. Only 19% of centers that were contacted agreed to contribute data to the Consortium. Additionally, the researchers do not assess the quality of the studies included in their meta-analysis. Regardless, observational data should not be used to trump the RCT data included in the recent, Cochrane review. Finally, Roche pharmaceuticals was a major sponsor of this research team. The accompanying editorial is a must-read.
Recommended by: Anand Swaminathan
Infection Control, Hand hygiene
D’Egidio G et al. A study of the ...
Source: Life in the Fast Lane - July 10, 2014 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Anaesthetics Cardiology Emergency Medicine Featured Infectious Disease Intensive Care Neurology Palliative care R&R in the FASTLANE Radiology Resuscitation Trauma critical care literature recommendations research and reviews Source Type: blogs
Management of hepatic encephalopathy in hospital
var gaJsHost = (("https:" == document.location.protocol) ? "https://ssl." : "http://www."); document.write(unescape("%3Cscript src='" + gaJsHost + "google-analytics.com/ga.js' type='text/javascript'%3E%3C/script%3E")); Review ArticleLeise MD, Poterucha J, Kamath PS et. al. Management of hepatic encephalopathy in the hospital. Mayo Clin Proc 2014; 89(2) 241-253.Working Party for hepatic encephalopathy nomenclature:Type A HE-- secondary to liver failureType B HE enteric hyperammonemia without liver diseasevar pageTracker = _gat._getTracker("UA-3639768-12"); pageTracker._initData(); pageTracker._trackPageview(); T...
Source: neurologyminutiae - May 16, 2014 Category: Neurologists Source Type: blogs
Answer to Case 294
Answer: Blastocystis hominisThanks to everyone who wrote in with the response - you were all correct. Blastocystis is most commonly present in stool as cysts (vacuolated forms/central-body forms) which contain a large central body similar to a vacuole and up to 4 peripheral nuclei. As mentioned by Florida Fan, they range in size from 5 to 20 (or even 30) micrometers in diameter, although the usual range is 8-10 micrometers.There were a number of comments/questions about the Blastocystis subtype and how that might be linked to the patient's symptoms. At this time, the role of this protozoan parasite as a h...
Source: Creepy Dreadful Wonderful Parasites - March 2, 2014 Category: Pathologists Source Type: blogs
Metronidazole and alcohol
(Source: Notes from Dr. RW)
Source: Notes from Dr. RW - February 23, 2014 Category: Internists and Doctors of Medicine Tags: infectious disease pharmacology toxicology Source Type: blogs
Why he had not peed in 2 days
To restate:
A 55-year-old man comes to the ER for RUQ abdominal pain for the past week, getting worse, and diarrhea (4-6 semi-formed stools daily. His vital signs show tachycardia, normal respiratory rate, and a normal BP. He has a positive Murphy’s sign, but otherwise his abdomen just appears distended.
Labs:
129
80
101
144
4.6
15
8.6
6.9
pH 7.27
pCO2 37
pO2 91
HCO3 17
========
When first presented with this story at morning report, these were my thoughts:
Mild hyponatremia, will not address at this time
Increased anion gap acidosis – 34 – must evaluate
Metabolic alkalosis – ask for...
Source: DB's Medical Rants - December 22, 2013 Category: Health Medicine and Bioethics Commentators Authors: rcentor Tags: Acid-Base & Lytes Attending Rounds Source Type: blogs
Worrier In Chief
Saul couldn't have been a nicer guy. The story behind his arrival to the nursing home was long and sorted. But now we had a black gangrenous foot to deal with. The culprit, not the toe ulcer that brought him in to the hospital in the first place, but small thrombosed blood vessels from heparin induced thrombosis and thrombocytopenia, a reaction to a medication given as a precaution.
The vascular surgeon was equivocal, amputation versus watchful waiting. Toes can autonecrose (self amputate), but when the black tide of dead tissue spread towards the ankle our options became limited. As the white count began to rise, I had t...
Source: In My Humble Opinion - September 5, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
Funny Allergy Quotes, Jokes, Stories and a List of Crazy Reactions.
If you're looking for funny allergy quotes, jokes and stories you've come to the right place. I asked my readers from facebook to provide me with their experiences they've had regarding crazy allergy reactions and they did not let me down. They relayed dozens of incidents they've experienced through the years. Over the years I've discovered several funny allergies myself, including allergies to prednisone, diet products and the color red. Some patients have dozens of allergies. My experience is that most of these allergies are not allergies in the physiological sense. The te...
Source: The Happy Hospitalist - July 2, 2013 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous Source Type: blogs
