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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
about 4 years ago
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Cyclic Vomiting Syndrome: Pearls and Pitfalls - emdocs

emDocs post containing very useful emergency medicine information  
emdocs.net
about 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
about 4 years ago
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7

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
about 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
about 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
about 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
about 4 years ago
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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
about 4 years ago