Introduction with a case 0 Once upon a time a 60-year-old man was transferred from the oncology ward to the ICU for treatment of neutropenic septic shock.
almost 6 years ago
This is a chart including testing information to differentiate between different bacteria causing STDs and UTIs. It also includes urine dipstick testing. Pink is gram negative bacteria and blue is gram positive. The document is in word format so it can be changed and updated as needed.
over 7 years ago
This is an excerpt from "Fluids and Electrolytes Made Incredibly Easy! 1st UK Edition" by William N. Scott. For more information, or to purchase your copy, visit: http://tiny.cc/Fande. Save 15% (and get free P&P) on this, and a whole host of other LWW titles at lww.co.uk when you use the code MEDUCATION when you check out! Introduction The chemical reactions that sustain life depend on a delicate balance – or homeostasis – between acids and bases in the body. Even a slight imbalance can profoundly affect metabolism and essential body functions. Several conditions, such as infection or trauma, and certain medications can affect acid-base balance. However, to understand this balance, you need to understand some basic chemistry. Understanding pH Understanding acids and bases requires an understanding of pH, a calculation based on the concentration of hydrogen ions in a solution. It may also be defi ned as the amount of acid or base within a solution. Acids consist of molecules that can give up, or donate, hydrogen ions to other molecules. Carbonic acid is an acid that occurs naturally in the body. Bases consist of molecules that can accept hydrogen ions; bicarbonate is one example of a base. A solution that contains more base than acid has fewer hydrogen ions, so it has a higher pH. A solution with a pH above 7 is a base, or alkaline. A solution that contains more acid than base has more hydrogen ions, so it has a lower pH. A solution with a pH below 7 is an acid, or acidotic. Getting your PhD in pH A patient’s acid-base balance can be assessed if the pH of their blood is known. Because arterial blood is usually used to measure pH, this discussion focuses on arterial samples. Arterial blood is normally slightly alkaline, ranging from 7.35 to 7.45. A pH level within that range represents a balance between the concentration of hydrogen ions and bicarbonate ions. The pH of blood is generally maintained in a ratio of 20 parts bicarbonate to 1 part carbonic acid. A pH below 6.8 or above 7.8 is usually fatal. Too low Under certain conditions, the pH of arterial blood may deviate significantly from its normal narrow range. If the blood’s hydrogen ion concentration increases or bicarbonate level decreases, pH may decrease. In either case, a decrease in pH below 7.35 signals acidosis. Too high If the blood’s bicarbonate level increases or hydrogen ion concentration decreases, pH may rise. In either case, an increase in pH above 7.45 signals alkalosis. Regulating acids and bases A person’s well-being depends on their ability to maintain a normal pH. A deviation in pH can compromise essential body processes, including electrolyte balance, activity of critical enzymes, muscle contraction and basic cellular function. The body normally maintains pH within a narrow range by carefully balancing acidic and alkaline elements. When one aspect of that balancing act breaks down, the body can’t maintain a healthy pH as easily, and problems arise.
Lippincott Williams & Wilkins
almost 9 years ago
Complimentary medicine (CAM) is controversial, especially when it is offered by the NHS! You only have to read the recent health section of the Telegraph to see Max Pemberton and James LeFanu exchanging strong opinions. Most of the ‘therapies’ available on the market have little to no evidence base to support their use and yet, I believe that it has an important role to play in modern medicine. I believe that CAM is useful not because of any voodoo magic water or because the soul of a tiger lives on in the dust of one of its claws but because modern medicine hasn’t tested EVERYTHING yet and because EVERY DOCTOR should be allowed to use a sugar pill or magic water to ease the anguish of the worried well every now and again. The placebo effect is powerful and could be used to help a lot of patients as well as save the NHS a lot of money. I visited my grandfather for a cup of coffee today. As old people tend to do we discussed his life, his life lessons and his health . My grandfather is 80-something years old and worked as a collier underground for about 25 years before rising up through the ranks of management. In his entire life he has been to hospital twice: Once to have his tonsils removed and once to have a TKR – total knee replacement. My granddad maintains that the secret of his good health is good food, plenty of exercise, keeping his mind active and 1 dried Ivy berry every month! He takes the dried ivy berries because a gypsie once told his father that doing so would prevent infection of open wounds; common injuries in those working under ground. It is my granddad’s firm belief that the ivy berries have kept him healthy over the past 60 years, despite significant drinking and a 40 year pack history! My grandfather is the only person I know who takes this quite bizarre and potentially dangerous CAM, but he has done so for over half a century now and has suffered no adverse effects (that we can tell anyway)! This has led me to think about the origin of medicine and the evolution of modern medicine from ancient treatments: Long ago medicine meant ‘take this berry and see what happens’. Today, medicine means ‘take this drug (or several drugs) and see what happens, except we’ll write it down if it all goes wrong’. Just as evidence for modern therapies have been established, is there any known evidence for the ivy berry and what else is it used for? My grandfather gave me a second piece of practical advice this afternoon, in relation to the treatment of open wounds: To stop bleeding cover the wound in a bundle of spiders web. You can collect webs by wrapping them up with a stick, then slide the bundle of webs off the stick onto the wound and hold it in place. If the wound is quite deep then cover the wound in ground white pepper. I have no idea whether these two tips actually work but they reminded me of ‘QuickClot’ (http://www.z-medica.com/healthcare/About-Us/QuikClot-Product-History.aspx) a powder that the British Army currently issues to all its frontline troops for the treatment of wounds. The powder is poured into the wound and it forms a synthetic clot reducing blood loss. This technology has been a life-saver in Afghanistan but is relatively expensive. Supposing that crushed white pepper has similar properties, wouldn’t that be cheaper? While I appreciate that the two are unlikely to have the same level of efficacy, I am merely suggesting that we do not necessarily dismiss old layman’s practices without a little investigation. I intend to go and do a few searches on pubmed and google but just thought I’d put this in the public domain and see if anyone has any corroborating stories. If your grandparents have any rather strange but potentially useful health tips I’d be interested in hearing them. You never know they may just be the treatments of the future!
over 8 years ago
Fecal microbiota transplantation, as a microbiota-target therapy, is arguably very effective for curing Clostridium difficile infection and has good outcomes in other intestinal diseases. New insights have raised an interest in FMT for the management of extra-intestinal disorders associated with gut microbiota. This review shows that it is an exciting time in the burgeoning science of FMT application in C. Difficile infection and previously unexpected areas, including metabolic diseases, neuropsychiatric disorders, autoimmune diseases, allergic disorders, and tumors.
over 6 years ago
The diagnosis of urinary tract infection (UTI) in young children is important as a marker for urinary tract abnormalities. It may be associated with life-threatening...
over 6 years ago
Very good case in showing a frequently overlooked issue of diuretics. Remember, there is almost never a reason to give both fluids and diuretics...make up your mind. IV fluids are the #1 method to try in oliguric pts NOT Lasix.Do not agree with Foley cath placement if patient is able to urinate and can check creatinine to know pt is improving. Any catheter is a foreign body and increases infection risk.It is also very uncomfortable for patients.Not sure why U/S of kidney needed right away either unless the patient has chronic kidney disease or does not improve with fluids.Unnecessary tests add to the expense of healthcare which all of us pay for. This increases insurance costs, medicaid costs, etc so much it can put companies (and gov't in the future?) out of business.
over 6 years ago
Kanner’s infantile autism and Asperger’s syndrome -- Pearce 76 (2): 205 -- Journal of Neurology, Neurosurgery & Psychiatry
Recent much publicised attention to autism and its putative relation to the measles, mumps, and rubella (MMR) vaccination reminds us that autism affects approximately 4 in 10 000 of the population. It is characterised by impairments in reciprocal social interaction and communication, restricted and stereotyped patterns of interests and activities, and the presence of developmental abnormalities by 3 years of age. Much of the psychiatric literature appears to overlook the organic basis,1 with subtle neurological signs evident in many examples: learning difficulties, a high incidence of epilepsy, viral infections, tuberous sclerosis, and fragile X syndrome are known associations.
over 6 years ago
<p><span style="color: #333333; font-size: small;">This episode covers an approach to children with altered level of consciousness. We present an approach to the initial management in these cases, with a focus on the ABC and DFG approach. Investigations and imaging are discussed. Some specific causes of altered LOC are covered. This episode was written by Peter MacPherson and Dr. Melanie Lewis. Peter is a medical student at the University of Alberta. Dr. Lewis is a general pediatrician and an Associate Professor of Pediatrics at the University of Alberta and Stollery Children's Hospital. She is also the Clerkship Director. </span></p <p><span style="color: #333333; font-size: small;">~~~</span></p <p><!--StartFragment--></p <p class="MsoNormal"><span style="font-family: Times;"><span style="font-size: small;"> <!--StartFragment--> </span></span></p <p class="MsoNormal"><span style="font-family: Verdana;">Differential Diagnosis of Altered Level of Consciousness:</span></p <p class="MsoNormal"><span style="font-family: Verdana;">1) Structural causes: cerebrovascular accident, cerebral vein thrombosis, hydrocephalus, intracerebral tumor, subdural empyema, trauma (intracranial hemorrhage, diffuse cerebral swelling, abusive head trauma/shaken baby syndrome)</span></p <p class="MsoNormal"><span style="font-family: Verdana;">2) Medical causes: anoxia, diabetic ketoacidosis, electrolyte abnormality, encephalopathy, hypoglycemia, hypothermia or hyperthermia, infection (sepsis), inborn errors of metabolism, intussusception, meningitis or encephalitis, psychogenic, postictal state, toxins, uremia (hemolytic-uremic syndrome)</span></p <div style="border: none; border-bottom: solid windowtext .75pt; padding: 0in 0in 1.0pt 0in;" <p class="MsoNormal" style="border: none; mso-border-bottom-alt: solid windowtext .75pt; padding: 0in; mso-padding-alt: 0in 0in 1.0pt 0in;"><span style="font-family: Verdana;">Adapted from: Avner J (2006) Altered states of consciousness. <em>Pediatr Rev</em></span><span style="font-family: Verdana;"> 27: 331-338.</span></p </div <p> </p>
over 11 years ago
A summary of the role and composition of normal flora, the typical bacterial pathogens causing several common infectious diseases, diagnosis of UTI, and interpretation as to whether a positive blood culture represents true infection or contamination. Bonus points to anyone who can identify the mystery portrait.
almost 8 years ago
This is a condition caused by infection of the endocardium by bacteria, or rarely, fungus. It most commonly affects the heart valves (natural or prosthetic), but can occur anywhere along the lining of the heart or blood vessels. It will most commonly occur at sites of previous damage, however, particularly virulent organisms (such as staphylococcus aureus and streptococcus pneumoniae) can infect previously normal areas of tissue; for example, Staph. Aureus will commonly infect the tricuspid valve in IV drug users.
almostadoctor.com - free medical student revision notes
almost 8 years ago