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Giant Bilateral Hemorrhagic Adrenal Myelolipomas

What did CT scan reveal about the cause of this patient's left flank pain associated with nausea and vomiting?  
medscape.com
over 4 years ago
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An apple juice a day? – Don't Forget the Bubbles

Pippi, aged 3, has been a little bit unwell of later.  Most of her family have had viral gastroenteritis and she has now got it too.  She’s been vomiting for the last 24 hours and is struggling to keep anything down.  Her parents are concerned that she is becoming dehydrated so they bring her into the ED.  She gets a sublingual ondansetron wafer and tries some oral rehydration solution.  “Yeuch!” she says as she spits it out, “That tastes disgusting.” You wonder if there is anything else you can try.  
dontforgetthebubbles.com
over 4 years ago
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Lab Case 101 – Interpretation

HHS usually develops over a course of days to weeks, unlike diabetic ketoacidosis (DKA), which develops more rapidly, over the course of a few days. Often, a preceding illness results in several days of increasing dehydration. Adequate oral hydration may be impaired by concurrent acute illness (eg, vomiting) or chronic comorbidity (eg, dementia, immobility).  
emergucate.com
over 4 years ago
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A Major Advance Against Chemotherapy's Most Feared Side Effect

Dr Mark Kris discusses a study showing that olanzapine is safe and effective for chemotherapy-induced nausea and emesis.  
medscape.com
over 4 years ago
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Fever with seizure and confusion

A 41 year old previously healthy man presented with a six day history of fever, headache, and vomiting, followed by two episodes of staring spells and unresponsiveness and secondarily generalised tonic-clonic seizures. In the emergency department he was restless, inattentive, and not oriented to time, place, and person (Glasgow coma score 10/15; best eye opening response (E): 3; best motor response (M): 5 and best verbal response (V):2). He had neck stiffness; Kernig’s sign was positive and his ocular fundi were normal. He had no limb weakness or ataxia and deep tendon reflexes and plantar reflexes were normal. He tested negative for HIV1/2 antigen and antibody. His blood coagulation profile and platelet count were normal. An initial unenhanced computed tomogram of the brain found no contraindications for lumbar puncture. Analysis of cerebral spinal fluid (CSF) showed glucose 3.4 mmol/L (reference range 2.2-3.9 mmol/L; corresponding blood glucose was 5.8 mmol/L), protein 2.59 g/L (0.15-0.45 g/L), 450×106 white blood cells/L (100% lymphocytes; 0-5×106), and 40×106 red blood cells/L. Gram staining of the CSF was negative and bacterial culture was sterile. A confirmatory microbiological test was performed on his CSF and computed tomography of the brain repeated the second week after the onset of symptoms (fig 1⇓).  
feeds.bmj.com
over 4 years ago
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Fever with seizure and confusion

A 41 year old previously healthy man presented with a six day history of fever, headache, and vomiting, followed by two episodes of staring spells and unresponsiveness and secondarily generalised tonic-clonic seizures. In the emergency department he was restless, inattentive, and not oriented to time, place, and person (Glasgow coma score 10/15; best eye opening response (E): 3; best motor response (M): 5 and best verbal response (V):2). He had neck stiffness; Kernig’s sign was positive and his ocular fundi were normal. He had no limb weakness or ataxia and deep tendon reflexes and plantar reflexes were normal. He tested negative for HIV1/2 antigen and antibody. His blood coagulation profile and platelet count were normal. An initial unenhanced computed tomogram of the brain found no contraindications for lumbar puncture. Analysis of cerebral spinal fluid (CSF) showed glucose 3.4 mmol/L (reference range 2.2-3.9 mmol/L; corresponding blood glucose was 5.8 mmol/L), protein 2.59 g/L (0.15-0.45 g/L), 450×106 white blood cells/L (100% lymphocytes; 0-5×106), and 40×106 red blood cells/L. Gram staining of the CSF was negative and bacterial culture was sterile. A confirmatory microbiological test was performed on his CSF and computed tomography of the brain repeated the second week after the onset of symptoms (fig 1⇓).  
feeds.bmj.com
over 4 years ago
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Cyclic Vomiting Syndrome: Pearls and Pitfalls - emdocs

emDocs post containing very useful emergency medicine information  
emdocs.net
over 4 years ago
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Imaging Case of the Week 198

These erect and supine abdominal x-rays are from a 35 year old experiencing severe abdominal pain and vomiting, and with a history of ulcerative colitis. What do the x-ray images indicate?  
emergucate.com
over 4 years ago
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Lab Case 97

A 59 year old man presents to your ED with epigastric pain and vomiting. He is tender in the epigastrium with good bowel sounds.  
emergucate.com
over 4 years ago
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Lab Case 97 – Interpretation

Compensated hyponatraemic, hypokalaemic, hypochloraemic metabolic alkalosis without evidence of renal failure or hypoglycaemia consistent with significant vomiting. Likely to indicate vomiting over a prolonged period of time.  
emergucate.com
over 4 years ago
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Imaging Case of the Week 195

This erect abdominal x-ray is from a 75 year old presenting with abdominal pain and vomiting. A supine x-ray of the abdomen could not be obtained as the patient became unwell soon after the erect image was taken. What can be observed?Answer will be posted on 09/03/2016.  
emergucate.com
over 4 years ago
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Vomiting in the Young Child: Nothing or Nightmare

In children with malrotation, 50% present within the first month of life, with the majority occurring in the first week after birth. Approximately 90% of children with malrotation with volvulus will present by one year of age.   This is a pre-verbal child’s disease – which makes it even more of a challenge to recognize quickly.  
pemplaybook.org
over 4 years ago
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Radiology Case 28 - Intensive Care Network

ICU Radiology Case - vomiting and abdominal distension  
intensivecarenetwork.com
over 4 years ago
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The critically ill patient vomiting blood - INTENSIVE

Here are the additional learning resources from the LITFL CCC for today’s simulation session at The Alfred ICU, which focussed on the critically ill haematemesis patient.  
intensiveblog.com
over 4 years ago
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Dr. Smith's ECG Blog: Nausea and Vomiting, Again. This ECG is loaded with information.

Instructive ECGs in Clinical Context ----Archives, Popular Posts, and an Index of all ECGs are down the right-hand side.  
hqmeded-ecg.blogspot.com
over 4 years ago
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Duplication of Gallbladder and Horse-Shoe Kidney

Abdominal imaging of this 9-year-old boy with nausea, vomiting, and abdominal pain revealed a rare combination of congenital defects.  
medscape.com
over 4 years ago
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Updated CINV Guidelines: New Evidence for Change and Practical Issues CME/CE

This activity is intended for oncologists, nurses, and pharmacists, as well as other clinicians who treat patients at risk for or who experience chemotherapy-induced nausea and vomiting (CINV).  
medscape.org
over 4 years ago
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PEM Playbook - Vomiting in the Young Child: Nothing or Nightmare - emdocs

In the young child, vomiting is the great imitator: Gastrointestinal, Neurologic, Metabolic, Respiratory, Renal, Infectious, Endocrine, Toxin-related, even Behavioral. To help us organize, below is a review of can’t-miss diagnoses by age.  
emdocs.net
over 4 years ago
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FDA Expands Use of Single-Use Antiemetic Fosaprepitant

The FDA has approved single-dose fosaprepitant dimeglumine to prevent delayed nausea and vomiting in patients who receive moderately emetogenic chemotherapy.  
medscape.com
over 4 years ago
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JC: Can alcohol relieve nausea. St.Emlyn's - St.Emlyn's

Whilst I was a medical student, I ran several ‘n of 1’ clinical trials, principally investigating whether alcohol could reduce nausea. My notes from these studies were incomprehensible scrawls, and in all honesty the results seemed to disprove my null hypothesis. My early experience, and my subsequent experience as an emergency physician in Virchester rather suggests that alcohol is definitely associated with nausea and vomiting. But maybe we’ve been doing it wrong. So, I was pretty excited to see what Beadle et al found in their trial investigating whether Isopropyl Alcohol wipes could reduce nausea in the Emergency Department. This idea has apparently been around for years with one of the Virchester consultants telling me that this was first mooted in the early 90’s, before iPhones, EBM or #FOAMed.  
feedproxy.google.com
over 4 years ago