Professional Documents
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SEPT 2013 1) Adenxal torsion- well, here is a score to help you- abdominal pain, o arian pain, !unbearable! pain!, omitin" and absence o# menorra"hia were all assi"ned points and these help ma$e a dia"nosis%&'um (eprod 2)&*+23,-+% . thin$ this is silly% They only saw 31 patients with this out o# /31 patients with pel ic pain and to tell you the truth- li$e testicular torsion- there does not seem to be subtle cases- i# they ha e they will loo$
sic$% . mean li$e- 01oh TA2E '34E 4ESSA5E6 Adnexal torsion patients loo$ sic$% This is not a dia"nosis you should miss% 2) (are that . brin" a 7E84 article but this one is so E4 &and written by an EP+ and yet had important points% 9eh, you $now the opiod syndrome- respiratory depression, miosis &absent in cocaine, and pethadine &which in the states is
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started 3) .# you are a lon" time reader o# E4B, you $now . lo e the wor$ o# Paul 4ari$, and .CB "uy that was at Alle"heny 5eneral and now is at East =ir"inia% 'e did a metaanalysis and #ound that new e idence seems to con#irm that i# your patient is not obese D the in#ection rates o# #emoral ersus .8 ersus SC C=Ps are about the same% &CC4 /0&*+2,2*+ This is contrary to
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camels roamin" around your country or somethin" similar that drin$s a lot be#ore "oin" to wor$% 9es, you BSA "uysthere are camels in AriEona #rom a #ailed military experiment
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trouble
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.t is trans#usion related acute lun" in:ury% There are ris$ #actors #or this- li er transplant patients, alcohol abuse, shoc$, hyper$alemia, patients "ettin" whole blood and multiple trans#usions, and those with anti 'AA and anti '7A type blood& not sure i# your patient has this> As$ your resident ampire D he is sure to $now+ Spea$in" o# ampires- here is a picture o# 5rand pa- who
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played him and on what series> .nterestin"ly enou"h D #emale blood also seems to cause more T(AA. so be care#ul about "i in" "irl blood to these other patients with ris$s &why is this> Pre ious auotantibodies>+ @hat are the sympthoms> dyspnea, tachycardia hypoxemia, #e er-FG- and most importantly D pulmonary in#iltrates that are not C'<% Treatment is supporti e and EC43% &Crit Care Clinics 2*&3+3?3+% TA2E '34E 4ESSA5E6 T(AA. has ris$
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shortness o# breath 6) .mportant point here% . wor$ed in a place where you could not ta$e blood cultures i# the patient was bein" dischar"ed% . wor$ed in places where you too$ blood cultures on all patients- -howe er . ne er wor$ed at a place where you too$ them on selected patients e en i# they had #e er% 3ur pals in .4 li$e them on all #e ers- but indeed- i# you do not ha e ri"or or S.(S criteria- they may not be too help#ul% Cellulitis and
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cultures
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hec$ understands derm> 8ust "i e it some Aatin name, "i e a steroid cream and send them #or a biopsy% 7o, really, here are their pearls- "ood luc$H (ecurrent erythema multi#ormeshould ma$e you thin$ o# a 'S= in#ection D "i e them acylco ir% Strep throat can cause a rash that loo$s li$e red drops% This is not a dru" reaction but rather "uttate psoriasis which the strep causes to exacerbate% Phototherapy may be enou"h% 'ard s$in in the nec$ area- i# the patient has 04, paraprotinemia and strep in#ections- thin$ scleroderma% 7ow here is the part o# this para"raph to i"nore% (eally . mean it% 9ou can also see scleroderma in multiple myeloma, hyperparathyroidism, S:or"en1s , insulinoma, rheumatoid, and '.=% 3ther diabetes s$in disorders6 candida, diabetic dermopathy &brown spots+, diabetic bullae, necrobiosis lipoidica, acanthosis ni"ra, insulin dystrophy and xanthoma% 5ood "rie#- who cares> &4ayo Clinic Proc *)&)+ ?-,+ TA2 E'34E 4ESSA5E6 9ou aren1t "oin" to catch these rashes, but
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8) 9ou thou"ht you should s$ip the last para"raph- boy D this is
really "oin" to put you sleep% P alues really are not that "ood% They can be in#luenced by many thin"s% <irst o# all D what is a p alue> This is measure o# how much the data obtained does not match with the null hypothesis% Bsually less than 0%0, is considered bein" no correlation with the null hypothesis% 'owe er, multiple hypotheses, data dred"in"
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This is a chart #rom the article that will help you understand the con#idence inter al TA2E '34E 4ESSA5E6 Con#idence
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bashin" PP.s and we do $now they cause calcium to be poorly absorbed resultin" in more #ractures% . "uess the same could be said #or ma"nesium and indeed this study says that% & Aliment Pharm T'er 3?&,+/0,+% 'owe er, it could ta$e anywhere between 1/ days and 13 years o# therapy to occur and resol es #ast upon discontinuation o# the therapy% .n addition this is a meta analysis o# small studies and as always
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hypoma"nesiumia 10) 8ust a bone #or our naturalists out there% Colds in $ids- we $now that 3TC and prescription cold medicines do not wor$ andGor ha e serious side e##ects% Echinacea and inhaled steroids also do not wor$% =apor rubs, Einc &maybe- we
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doesn1t wor$ #or A;P 11) 9ou can reduce post AP headache- but li$e "ood psychiatristyou ha e to want to% .n this Juestionnaire &. $now, . $now D only ,1I responded+ most did not use atruamatic needles and most used bi""er needles% 4any- //I still recommend bedrest #or a prescribed period o# time and others used
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Especially i# you li$e blondes% 12) And now let1s tra el a little north to iew some more blondes in this Swedish study% They too$ all these women with pylo and "a e them either two wee$s or one wee$ o# Cipro% 5uess what> Se en days wor$ed :ust as well as 1/ &Aancet 3*0&-*/0+/?/+% Couldn1t #ind much wron" with this study, and we do $now that lon" durations o# antibiotics :ust increase
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but they only wor$ in 10I o# patients D perhaps some more in hi"her doses% .t is howe er, well tolerated &Post 5rad 4ed
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these articles% .n cla icle #racturesL $ids always remodeled well, adults a lot less- in any case there is a bi" mo ement now to sur"ically #ix displaced #ractures especially in adolescents & 8 Am Acad 3rtho Sur" 20&*+/-*+ Are these :ust sur"ery happy orthos> 'ard to say% 4alunion is #or real but is it a #unctional problem> 'ow much displacement> 4y ad iceconsult% TA2E '34E 4ESSA5E6 Cla icle #racture which are displaced may bene#it #rom sur"ical repair- who "ets an
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supposed to reduce cardiac death and 4.% There were si"ni#icant Juestions about the e##icacy and the sa#ety o# this dru" &it is blac$ boxed in the BSA+ &especially the PAAT3 trial+
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indications other than #or seiEures% 4ood disorders and anxiety D maybe, but SS(.s are better in the lon" term and in the short term clotiapine wor$s well% ;enEos are also not the best bet #or sedation &. li$e propo#ol+ and also not #or intubated patients% =alium seems to be immunosuppressi e, and has a relati ely lon" hal# li#e &don1t let them #ool you- so does midaEolam D due to #at redistribution+% 3 ersedation and undersedation are common and benEos cause a lot o# delirium% They wea$en respiratory muscles and increase .CB time% Alternati es> (emi#entanil, dexedotmidine and propo#ol do not cause delirium and ha e shorter hal# li#es & Chest 1/2&2+2*1+% TA2E '34E 4ESSA5E6 ;enEos are not really the
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1)+ @ill mention this one last time D another randomiEed study that shows that antibiotics are the way to "o #or appendicitis% Sure 1G/ o# the patients in this study ended up "o to the 3( and another 11I had a recurrence within one year, but "i in" antibiotics is much sa#er than operations
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