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Life in the Fast Lane
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- February 24, 2010
- 03:45 AM
- 60 views
Toxicology Conundrum #028
by sandnsurf in Life in the Fast Lane
A pharmacist in the Gibson Desert wanted to take part in the recent mass homeopathic overdose protest organized by the 10:23 movement. Unbeknown to him, the cleaning lady had been around and accidentally mixed up the homeopathic pills with slow release verapamil. After gulping down a couple of handfuls of pills, the pharmacist's heightened gustatory awareness alerted him to the presence of verapamil in the tablets. Although he remains asymptomatic, he has a feeling that something bad might hap........ Read more »
Nickson CP, & Little M. (2009) Early use of high-dose insulin euglycaemic therapy for verapamil toxicity. The Medical journal of Australia, 191(6), 350-2. PMID: 19769561
- February 8, 2010
- 07:48 PM
- 87 views
Pediatric Perplexity #001
by sandnsurf in Life in the Fast Lane
A 7 year-old girl was brought to hospital with lethargy, irritability and vomiting. A week previously she developed chicken pox, and was treated with regular aspirin and paracetamol for fever and discomfort.... Read more »
Glasgow JF, & Middleton B. (2001) Reye syndrome--insights on causation and prognosis. Archives of disease in childhood, 85(5), 351-3. PMID: 11668090
Schrör K. (2007) Aspirin and Reye syndrome: a review of the evidence. Paediatric drugs, 9(3), 195-204. PMID: 17523700
- February 6, 2010
- 05:23 AM
- 92 views
Sternoclavicular Joint Dislocations
by sandnsurf in Life in the Fast Lane
Sternoclavicular dislocation is a relatively uncommon injury that can be easily missed or misdiagnosed. The importance in determining the direction of dislocation is emphasised by the dichotomy of management.... Read more »
Saltzman, M., Mercer, D., Bertelsen, A., Warme, W., & Matsen, III, F. (2009) Bilateral posterior sternoclavicular dislocations. Radiology Case Reports, 4(1). DOI: 10.2484/rcr.v4i1.256
- February 4, 2010
- 07:22 PM
- 103 views
Toxicology Conundrum #024
by sandnsurf in Life in the Fast Lane
A 23 year-old male is brought to your ED by a friend. He appears anxious, distressed and confused. His friend volunteers that the patient had seen a GP in the past few weeks as he was feeling depressed. The friend also admitted that the patient occasionally used recreational drugs such as marijuana and ecstasy. Further of examination of the patient was notable for the presence of shaking eye movements, brisk deep tendon reflexes and stiffness of the lower limbs...
Related posts:Toxicology Conu........ Read more »
Boyer EW, & Shannon M. (2005) The serotonin syndrome. The New England journal of medicine, 352(11), 1112-20. PMID: 15784664
Dunkley EJ, Isbister GK, Sibbritt D, Dawson AH, & Whyte IM. (2003) The Hunter Serotonin Toxicity Criteria: simple and accurate diagnostic decision rules for serotonin toxicity. QJM, 96(9), 635-42. PMID: 12925718
Isbister GK, Buckley NA, & Whyte IM. (2007) Serotonin toxicity: a practical approach to diagnosis and treatment. Medical Journal of Australia, 187(6), 361-5. PMID: 17874986
- February 1, 2010
- 07:11 PM
- 103 views
Metabolic Muddle #004
by sandnsurf in Life in the Fast Lane
You are asked to review a 73 year old lady who is in hospital for treatment of septic arthritis affecting a prosthetic right hip joint inserted 5 years earlier. The joint has been washed out and debrided twice, and she is receiving IV flucloxacillin and meropenem following culture of a methicillin-sensitive Staphylococcus aureus. She is on regular paracetamol for pain. Unfortunately, she has continued to deteriorate...
Related posts:Metabolic Muddle #003
Metabolic Muddle #001
Metabolic Muddle ........ Read more »
Dempsey GA, Lyall HJ, Corke CF, & Scheinkestel CD. (2000) Pyroglutamic acidemia: a cause of high anion gap metabolic acidosis. Critical care medicine, 28(6), 1803-7. PMID: 10890623
Mizock BA, & Mecher C. (2000) Pyroglutamic acid and high anion gap: looking through the keyhole?. Critical care medicine, 28(6), 2140-1. PMID: 10890683
Peter JV, Rogers N, Murty S, Gerace R, Mackay R, & Peake SL. (2006) An unusual cause of severe metabolic acidosis. The Medical journal of Australia, 185(4), 223-5. PMID: 16922670
- January 31, 2010
- 01:03 PM
- 89 views
Gastrointestinal Gutwrencher #001
by sandnsurf in Life in the Fast Lane
A 50 year-old man presented to the ED with sharp abdominal pain localised to his left lower quadrant.
Related posts:Pulmonary Puzzle #003
Trauma Tribulation #004
To Err is Human #001
... Read more »
Sand, M., Gelos, M., Bechara, F., Sand, D., Wiese, T., Steinstraesser, L., & Mann, B. (2007) Epiploic appendagitis – clinical characteristics of an uncommon surgical diagnosis. BMC Surgery, 7(1), 11. DOI: 10.1186/1471-2482-7-11
- January 18, 2010
- 03:10 AM
- 123 views
Signs of Imminent Admission
by sandnsurf in Life in the Fast Lane
Having trouble complying with the new 4 picosecond rule introduced by UCEM? Do not fret, you can improve your department's efficiency a thousandfold by religiously employing the 'Signs of 'Imminent Admission' as a disposition decision aid.... Read more »
Silverman JA, Kohn ML, & Referrals From the ER (REFER) Investigators. (2000) Will this emergency department patient be referred to internal medicine?. CMAJ : Canadian Medical Association journal , 163(12), 1566-7. PMID: 11138414
- January 13, 2010
- 08:48 PM
- 152 views
Are Redheads Bleeders?
by sandnsurf in Life in the Fast Lane
I first became aware that redheads were treated differently in medicine when I started hanging around anaesthetists. Most anaesthetists i know tend to get slightly more uptight when they see the phaeomelanin-laden locks of a freckled UV-sensitive patient. Especially in obstetrics. Why is this you ask?... Read more »
Liem EB, Lin CM, Suleman MI, Doufas AG, Gregg RG, Veauthier JM, Loyd G, & Sessler DI. (2004) Anesthetic requirement is increased in redheads. Anesthesiology, 101(2), 279-83. PMID: 15277908
- January 7, 2010
- 05:14 PM
- 133 views
Ophthalmology Befuddler #001
by sandnsurf in Life in the Fast Lane
An medical student on your team asks you to review an 81 year-old female who speaks little English. She was BIBA to the ED following a fall. Her nursing home transfer sheet says that the fall was witnessed: she tripped and there was no loss of consciousness. The student is concerned that the patient's right pupil is fixed and slightly dilated in the presence of facial abrasions.... Read more »
Hunter, T., Yoshino, M., Dzioba, R., Light, R., & Berger, W. (2004) Medical Devices of the Head, Neck, and Spine. Radiographics, 24(1), 257-285. DOI: 10.1148/rg.241035185
- January 7, 2010
- 03:13 AM
- 126 views
Don’t put your Patient in a Box
by Chris Nickson in Life in the Fast Lane
The fourth rule of Expensive Scare Medicine: 'If you measure something and it is not normal, make it normal if it is safe to do so'. But beware! This can lead to a dangerous and insatiable desire for 'euboxia' - the pathophysiological state whereby 'all boxes on a pathology print-out are in the normal range'.... Read more »
Reade MC. (2009) Should we question if something works just because we don't know how it works?. Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine, 11(4), 235-6. PMID: 20001869
- September 14, 2009
- 12:00 AM
- 60 views
Isolated Volar Distal Ulnar Dislocation
by sandnsurf in Life in the Fast Lane
Dislocation of the distal radio-ulna joint (DRUJ) is an extremely rare injury, particularly when it occurs without associated fractures of the distal radius and ulna. Isolated volar dislocations of the ulna in relation to the radius are much less common than dorsal dislocations because specific mechanisms are required to generate such an injury. As a result of this, plus the subtlety of clinical signs, they are missed in as many as 50% of cases in the acute period, delaying appropriate treatment........ Read more »
Mittal R, Kulkarni R, Subsposh SY, & Giannoudis PV. (2004) Isolated volar dislocation of distal radioulnar joint: how easy to miss!. European journal of emergency medicine : official journal of the European Society for Emergency Medicine, 11(2), 113-6. PMID: 15028903
- June 16, 2009
- 12:00 AM
- 66 views
Cement Embolus
by sandnsurf in Life in the Fast Lane
A 62 y/o caucasian female (Mrs S) presented to the Emergency Department with sudden onset of dyspnoea and local back pain. The patient had sustained a compression fracture of the 5th lumbar vertebral body 2 months previously and had Percutaneous Vertebroplasty (PVP) performed 4 days prior to her ED presentation.... Read more »
Kim, Y., Lee, J., Park, K., Yeom, J., Jeong, H., Park, J., & Kang, H. (2009) Pulmonary Cement Embolism after Percutaneous Vertebroplasty in Osteoporotic Vertebral Compression Fractures: Incidence, Characteristics, and Risk Factors. Radiology, 251(1), 250-259. DOI: 10.1148/radiol.2511080854
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