The Case 34 year-old woman with past medical history of postpartum cardiomyopathy (EF 15%) with AICD, mechanical mitral valve replacement, and depression was brought in by EMS for non-accidental ingestion of bupropion, furosemide, and warfarin. The dosage, number of tablets, and timing of ingestion was unknown. The patient was lethargic and Read more…
This month’s meeting of our Wilderness Medicine group discussed acute shoulder dislocations in the austere environment. Before we begin, let’s consider the following questions: Can the diagnosis of anterior shoulder dislocation be made clinically? Do all patients with anterior shoulder dislocations need a pre-reduction x-ray? If you answered ‘yes’ to Read more…
The Case 58 year-old man with history of mitral valve prolapse presents with 4 days of intermittent palpitations, lightheadedness, and shortness of breath. The symptoms resolve spontaneously. He denies any illicit substance use. Vital signs on arrival: T 97.5F, HR 71, BP 140/89, RR 18, SpO2 100% on room air. Read more…
By: Yonatan Yohannes, MD Abdominal Compartment Syndrome Who: The critically ill. Most commonly in shock, burn patients, polytrauma patients. What: Primary -> abdominopelvic disease/injury: trauma, pancreatitis, surgery, etc. Secondary -> conditions originating elsewhere: sepsis, burns When: Normal IAP (intra-abdominal pressure) 5-7mmHg IAH (intra-abdominal hypertension) IAP ≥ 12mmHg ACS Read more…
Well put Sebastian! If you are thinking massive PE then you are correct! (Follow this LINK to the initial post, with ECGs and question.) Definition of massive pulmonary embolism (PE) is a PE with cardiac arrest, systemic hypotension (SBP < 90mmHg or drop in SBP of at least 40mmHg Read more…
Presented by: Dr. Jaime Moran Summarized by: Dr. Yonatan Yohannes Reviewed by: Dr. Ian deSouza, Dr. Wendy Chan A guy walks into a bar and orders a drink. He syncopizes before taking his first sip. I know what you’re thinking and the answer is no, he didn’t pre-game (i.e. Read more…
A 19 yo male PMH sickle cell disease presents with body aches and joint pains x 2 days. Symptoms feel similar to prior acute vaso-occlusive crises. On ROS, he also notes chest pain and SOB starting 1 day prior to arrival. He is afebrile rectally, SaO2 95% on room air, Read more…
Presented by: Dr. Cassie Thomassin Summarized by: Dr. Yonatan Yohannes Reviewed by: Dr. Ian deSouza, Dr. Wendy Chan The Fictitious Case A 22 y/o F with PMH insulin-dependent DM and hypothyroidism is brought in by EMS for altered mental status. Family members on the scene noted she has been Read more…
If you guessed Type 1 Brugada syndrome, then you are correct! Pathophysiology Brugada syndrome is a disease resulting from a mutation in the SCN5A gene, which encodes a myocardial voltage-gated sodium channel. It is inherited via an autosomal dominant pattern with incomplete penetrance. Roughly half of reported cases are familial, Read more…
Deep Space Neck Infections! Anatomy Image from: http://www.uptodate.com/contents/image?imageKey=PEDS%2F74998&topicKey=ID%2F3415&rank=1~17&source=see_link&search=deep+neck+infection&utdPopup=true Types Peritonsillar space (abcess) Parotid space Submandibular space (Ludwig’s angina) Pretracheal space Prevertebral space Parapharyngeal space Retropharyngeal & danger space History & Physical Exam Findings – Dysphagia Read more…