Category: Orthopedics
Keywords: Sternoclavicular, Dislocation, Posterior (PubMed Search)
Posted: 3/24/2008 by Michael Bond, MD
(Updated: 4/8/2025)
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Sternoclavicular Dislocation:
Sorry this is being delivered to you late.
Category: Cardiology
Keywords: electrocardiography, EKG, cardiogenic shock, acute myocardial infarction (PubMed Search)
Posted: 3/23/2008 by Amal Mattu, MD
(Updated: 4/8/2025)
Click here to contact Amal Mattu, MD
Here's a nice, simple pearl for cardiogenic shock:
"A normal ECG virtually rules out shock due to myocardial infarction."
Essentially, even though MI may be associated with a normal ECG in approximately 5-8% of cases, if a patient has cardiogenic shock due to MI, the ECG will ALWAYS be abnormal.
Gowda RM, Fox JT, Khan IA. Cardiogenic shock: basics and clinical considerations. Int J Cardiol 2008;123:221-228.
Amal
Category: Pediatrics
Posted: 3/21/2008 by Sean Fox, MD
(Updated: 4/8/2025)
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Diarrhea and the Petting Zoo
Now that it is Spring Time, trips to the Zoo and to Pools will become more frequent… consider them as potential environmental exposure sites.
Petting Zoos, Farmers Markets and Fairs, and Swimming Pools (especially kiddie swimming pools) are known sources of enteropathogens that can cause diarrhea (sometimes bloody).
Consider these on your DDx of vomiting/diarrhea.
Ask about these possible exposure sites along with Travel History and Nontraditional Pets.
Category: Toxicology
Keywords: heparin, chondroitin, toxicity (PubMed Search)
Posted: 3/20/2008 by Fermin Barrueto
(Updated: 4/8/2025)
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Heparin FDA Alert
In case you had not heard, there was a major recall of Baxter's Heparin. It was responsible for dozens of deaths in the USA and an investigation was launched. It has been found that the contaminant comes from manufacturing plants in China. The most concerning part is that it looks like it was chemically synthesized sulfated chondroitin. This brings the suspicion of intentional adulteration. First lead in toys now cartilage in our heparin - what's next?
Some fascinomas of Heparin:
News link for FDA Heparin Alert:
http://www.fda.gov/medwAtch/safety/2008/safety08.htm#HeparinInj2
Category: Neurology
Keywords: tPA, stroke, intracerebral hemorrhage (PubMed Search)
Posted: 3/19/2008 by Aisha Liferidge, MD
(Updated: 4/8/2025)
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Category: Critical Care
Keywords: phosphate, hypotension, hypomagnesemia (PubMed Search)
Posted: 3/18/2008 by Mike Winters, MBA, MD
(Updated: 4/8/2025)
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Potassium Phosphate ("K-phos")
Over the weekend, I had a patient with Dr. Scott that had a phosphate of 0.8 mmol/L. Phosphate < 1.0 mmol/L is an indication for IV repletion. IV repletion involves giving potassium phosphate. An important clinical question, therefore, is how much potassium does the patient actually get?
Category: Cardiology
Keywords: cardiogenic shock, hypertrophic cardiomyopathy (PubMed Search)
Posted: 3/17/2008 by Amal Mattu, MD
(Updated: 4/8/2025)
Click here to contact Amal Mattu, MD
Cardiogenic shock associated with LV outflow obstruction is managed best without the use of vasoconstrictive agents and vasopressors. Ideally, patients should be treated with IVF and beta blockade. Alpha agonists (e.g. ISO) can also be added.
Typical vasopressors may actually worsen LV outflow obstruction in these patients.
Category: ENT
Keywords: Avulsed Tooth, hanks solution, dental emergencies (PubMed Search)
Posted: 3/16/2008 by Michael Bond, MD
(Updated: 4/8/2025)
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Dental Emergency -- Avulsed Tooth
Category: Pediatrics
Keywords: Gonorrhea, Chlamydia, Syphilis, Sexual Abuse, Trichomonas (PubMed Search)
Posted: 3/14/2008 by Sean Fox, MD
(Updated: 4/8/2025)
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Sexual Abuse
Category: Toxicology
Keywords: sumatriptan, myocardial infarction, migraine (PubMed Search)
Posted: 3/13/2008 by Fermin Barrueto
(Updated: 4/8/2025)
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Category: Neurology
Keywords: benign paroxsymal positional vertigo, vertigo, bppv, dix hallpike maneuver, dizziness (PubMed Search)
Posted: 3/12/2008 by Aisha Liferidge, MD
(Updated: 1/9/2010)
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Category: Gastrointestional
Keywords: Variceal Bleed (PubMed Search)
Posted: 3/11/2008 by Rob Rogers, MD
(Updated: 4/8/2025)
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Medical Regimen for Suspected Variceal Bleed
To review what Dr. Bond and Dr. Winters have already posted:
Three medical therapies have been shown to be effective in patients with severe upper GI bleed thought to be due to esophageal varices:
Most of our gastroenterologists recommend this regimen (all three therapies)
Other things to consider:
Category: Critical Care
Keywords: fresh frozen plasma, coagulopathy, PRBC (PubMed Search)
Posted: 3/11/2008 by Mike Winters, MBA, MD
(Updated: 4/8/2025)
Click here to contact Mike Winters, MBA, MD
Coagulopathy and Trauma
Category: Cardiology
Keywords: MI, Cardiogenic Sock (PubMed Search)
Posted: 3/8/2008 by Michael Bond, MD
(Updated: 4/8/2025)
Click here to contact Michael Bond, MD
Post-MI cardiogenic shock, while traditionally thought to carry a mortality > 80%, actually has perhaps half that mortality when patients are treated aggressively with prompt invasive therapy (PCI, possibly CABG). Fibrinolytics have traditionally been discouraged, but authors now indicate that they should be given if all of the following three conditions are present:
Sent on behalf of Dr. Amal Mattu
[adapted from: Reynolds HR, Hochman JS. Cardiogenic shock: current concepts and improving outcomes. Circulation 2008;117:686-697.]
Category: ENT
Keywords: Trigeminal Neuralgia, Microvascular decompression, treatment (PubMed Search)
Posted: 3/8/2008 by Michael Bond, MD
(Updated: 4/8/2025)
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Trigeminal Neuralgia
Category: Pediatrics
Keywords: Appendicitis, Delayed Surgical intervention, Perforation (PubMed Search)
Posted: 3/7/2008 by Sean Fox, MD
(Updated: 4/8/2025)
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Acute Appendicitis – Delayed Surgery option?
Category: Toxicology
Keywords: amiodarone, torsades, hypothyroidism, toxicity, adverse effects, medication induced (PubMed Search)
Posted: 3/6/2008 by Ellen Lemkin, MD, PharmD
(Updated: 4/8/2025)
Click here to contact Ellen Lemkin, MD, PharmD
Did you know how many toxicities and adverse effects amiodarone has? Many are severe, and many VERY common.
1. CARDIAC: hypotension with rapid infusion, prolonged QT, torsades
2. NEUROLOGIC problems occur in 20-40%, including malaise, ataxia, and peripheral neuropathies
3. ENDOCRINE: hypothyroidism and hyperthyroidism
4. GI problems occur in 25%
5. OPHTHALMOLOGIC disturbances include optic neuropathy, papilledema, and photosensitivity
6. SKIN: blue grey pigmentation
7. PULMONARY: pulmonary fibrosis
Category: Neurology
Keywords: nystagmus, cerebellar dysfunction (PubMed Search)
Posted: 3/6/2008 by Aisha Liferidge, MD
(Updated: 4/8/2025)
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Category: Critical Care
Keywords: aspiration pneumonitis (PubMed Search)
Posted: 3/4/2008 by Mike Winters, MBA, MD
(Updated: 4/8/2025)
Click here to contact Mike Winters, MBA, MD
Aspiration Pneumonitis
Category: Misc
Keywords: Oncologic, Emergency, SVC Syndrome (PubMed Search)
Posted: 3/3/2008 by Rob Rogers, MD
(Updated: 4/8/2025)
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Clinical Presentation of SVC Syndrome
SVC syndrome (caused either by tumor or thrombosis of the SVC) classically presents with facial swelling, arm swelling, and dilated chest wall veins. The problem in the real world is that often times the manifestaions are a bit more subtle.
Some SVC syndrome pearls: