Category: Critical Care
Keywords: central venous pressure (PubMed Search)
Category: Airway Management
Keywords: Asthma (PubMed Search)
Care of the Crashing Asthma Patient
Several things should be considered in the crashing asthmatic:
Keywords: adenosine, ventricular tachycardia (PubMed Search)
Adenosine should never be used in the setting of a wide complex regular tachycardia as a diagnostic maneuver. Adenosine will convert some types of VT, and this may mislead the health care provider into thinking that the WCT is an SVT. The electrophysiology literature is rife with reports of "adenosine-sensitive VT," and these patients are often young and without prior history of CAD...the very patients that we'd most be inclinded to assume have SVT.
The bottom line is that one should always assume that a regular WCT (without obvious evidence of sinus tachycardia) is VT, and treat the tachydysrhythmia as such.
Category: Infectious Disease
Keywords: Dermatology, Rash, (PubMed Search)
Most of use remember that Fifth disease is a viral infection presenting with a distinctive rash (slapped check) caused by Parvovirus B19. But do you know the numbering of the other six Contagious Illnesses that are associated with rashes:
Keywords: Ferbrile Seizures, Bacteremia, Fever (PubMed Search)
Here are a couple of herbals touted as aphrodesiac's and the toxcity associated with them (the price of love):
Chan Su or "Love Stone" - A chinese herbal that is suppose to be topically applied, unfortunately all of the instructions are in chinese and those who ingest it will die a digoxin-like death. It has a compound that is essentially a potent digoxin-like substance.
Yohimbine - herbals that contain this can cause priapism - shocker
Keywords: brainstem, cranial nerves (PubMed Search)
Category: Critical Care
Keywords: spontaneous pneumomediastinum (PubMed Search)
Keywords: AAA, aneurysm (PubMed Search)
AAA...be afraid, be very afraid
Abdominal Aortic Aneurysm (AAA) is known as the great masquerader in the elderly for good reason....
Keywords: acute coronary syndrome, history (PubMed Search)
The 5 most important factors at predicting the presence of ACS in a patient presenting with chest pain (in order of importance):
1. nature of anginal symptoms (i.e. the HPI)
2. prior history of CAD
3. male gender
4. older age
5. increasing number of traditional risk factors
Notice this means that the MOST important factor is the HPI...the OLDCAAAR. If the patient has a concerning HPI, NEVER drop your concerns just because the patient is young or has minimal other risk factors.
Category: Obstetrics & Gynecology
Keywords: Rhogam, Pregnancy (PubMed Search)
Trivial Fact: Rhogam is Pregnancy Class C
Keywords: Neonatal Conjunctivitis, Chlamydia, Gonorrhea, Red Eye (PubMed Search)
Neonate with Red Eye
Keywords: stroke, visual field cuts, peripheral vision (PubMed Search)
Keywords: Inferior Vena Cava, Physical Examination, Thrombosis (PubMed Search)
Physical Examination finding in inferior vena cava thrombosis
Consider IVC thrombosis if you ever see vertically oriented, dilated abdominal wall veins, or dilated veins on the back. As opposed to abdominal wall veins that radiate out from the umbilicus in patients with cirrhosis-known as caput medusae.
Etiologies include hepatic tumors abutting the IVC, renal cell tumors, open abdominal surgery, catheter related, IVC filter-related.
Keywords: clopidogrel, ACS, STEMI, myocardial infarction (PubMed Search)
The ACC/AHA just recently published a "Focused Update" of their guidelines for management of ST-elevation MI. Amongst the changes:
Clopidogrel 75 mg per day orally should be added to aspirin in patients with STEMI who receive thrombolytics.
Clopidogrel 300-600 mg orally should be added to aspirin in patients that are going for PCI for STEMI. This is listed as a Class I intervention, although the level of evidence is rated "C." In other words, it is judged to be definitely helpful though based on not-so-robust evidence (you figure that one out!).
Glycoprotein receptor antagonists can also be added (Class IIa, level of evidence B).
[I personally believe there is better evidence for the GP2B3A inhibitors than for clopidogrel, but there is a general push for more and more guideline writers to support clopidogrel. The number of writers for these ACC/AHA guidelines who have affiliations with the drug companies, including the ones that manufacture clopidogrel (Plavix), is tremendous; the list of disclosures is listed at the back of the document. Nevertheless, people tend to want to follow guidelines, and the boards will test you on this stuff so it is worth knowing.]
[Also for the record, if I have a STEMI, here's what I want: 162 mg ASA (not 325 mg), unfractionated heparin (not enoxaparin), abciximab/ReoPro (not eptifibitide/Integrilin) in the cath lab (not in the ER), and quick PCI; if I can't get the PCI within 60 minutes (not 90, but 60 minutes!), give me either tenectaplase or retaplase (not tPA) + 162 mg ASA + UFH; if I have a lot of pain that is not responding to NTG, give me dilaudid or fentanyl (not morphine)...and some Bailey's on ice; add oral BBs, ACEIs, and a statin at the 24 hour mark, NOT any earlier (early BBs only if I have Bailey's-resistant hypertension). Thanks.]
Keywords: crotimaton, permethrin, lindane (PubMed Search)
We have seen this lovely bug infect our patients and have to instutitue therapy. But do you know what is the first line drug and which one has now become second line due to its toxicity? Here is the short list:
First Line Therapy: Permethrin (Nix) - least toxic, only causes local irritation
Second Line Therapy: Crotamiton (Eurax) - again local irritation
Third LIne Therapy: Lindane - SEIZURES if you leave it on too long or put on too much. Children were particularly susceptible and relatively contraindicated.
Keywords: Metacarpal, Fracture, Boxer's Fracture (PubMed Search)
Metacarpal Neck Fractures (i.e.: Boxer’s Fracture if 5th Metacarpal)
Depending on the MCP joint involved a certain amount of angulation is permissible before it adversely affects normal function.
Keywords: Laceration, Dermabond, cyanocrylate (PubMed Search)
Cyanocrylate Tissue Adhesive is an excellent product to use when repairing linear lacerations.
A few things to remember:
The wound needs to be irrigated as you would any other wound prior to closure.
Gravity works. Consider where the product may drip to before you apply it (Eyes, Ears, Nose, etc).
Use Surgi-Lube (or other petroleum product) to create a barrier to limit the flow of the cyanocrylate.
For long lacerations, you may use steri-strips to help approximate edges before applying the tissue adhesive.
What to do if the glue gets out of control and drips onto the eyelids... may also apply to Krazy-Glue:
Use copious irrigation and then Mineral Oil (not acetone or alcohol - which won't go well in the eyes).
Often there will be an associated corneal abrasion... treat it as other corneal abrasion.
Keywords: hyperkalemia, medications (PubMed Search)
Keywords: DHE, dihydroergotamine, migraine headache, headache, cluster headache (PubMed Search)