Home
Ambi Oct's Library tagged → View Popular, Search in Google
""The kidney really is the canary in the coal mine of the cardiovascular system," Dr. Anderson said. "If your patients drop their GFR every time their blood pressure goes down a little bit, that's telling you they have vascular disease.""
serum creatinine doesn't even start to go up until you've lost half of your kidney function.24-hour urine and a urine protein-creatinine ratio or an albumin-creatinine ratio r never useful in AKI.All of these estimates are based on the premise of consistent urinary creatinine excretion, and in acute renal failure, it's not consistent," " Wait until the patient has recovered and is in a steady state. Then you can look for albuminuria and proteinuria and work it up as appropriate."
STOP ACEs/ARBs,NSAIDs,PPIs.
FIRST ORDER -urine microscopy is my most important diagnostic tool in trying to evaluate the cause of acute kidney injury
if patients are prerenal, it helps to look at the fractional excretion of sodium, particularly if the patient isn't on diuretics.
If patients are severely volume depleted or septic, stopping the diuretic is obviously the right course. But patients with cardiorenal syndrome can improve with diuretics. letting patients get too volume overloaded in the course of their acute kidney injury is really bad."general advice is to stop giving fluids at some point in the course of acute kidney injury, and then consider diuretics.
For septic patients, she said that it is reasonable to start volume resuscitation and get antibiotics on board.
Ordering an ultrasound to look for an obstruction."Don't always order it on the day that acute kidney injury is diagnosed," she said, "but don't forget about it either.
Look and see what people came in on, and make sure they go home on at least that much. When they go home, they're going to start eating a regular diet, and they will need their diuretics again.Don't worry solely about the creatinine levels," "Don't sacrifice the patient to save the kidneys."
dialysis only if you think you need it to manage a patient's volume or potassium levels
elderly patients with chronic kidney disease may not be getting the coronary angiograms they need "because everybody's afraid of contrast nephropathy." But not taking care of patients' heart disease results in a higher death rate.
in list: MEDEDU
"Citrus fruits, including oranges, lemons, limes, and grapefruits are rich in vitamin C, as are vegetables, including potatoes, broccoli, spinach, brussels sprouts, and red peppers.5 Fresh meat contains vitamin C, however it is destroyed when cooked. Therefore, fresh fruits and vegetables remain the best source of this essential vitamin. The recommended dietary allowance (RDA) for vitamin C is between 45 and 90 mg/day"
clinical signs due to an inadequate diet, can be seen within 8–12 weeks. oral vitamins including 250 mg of vitamin C, twice daily, Consuming five servings of fruits and vegetables per day . Symptoms of scurvy resolve in 3–5 days and most physical findings resolve in 1–2 weeks after acute management.2 Even patients who have progressed to multiple organ dysfunction and failure will rapidly resolve.
alcoholics with poor nutrition, isolated elderly patients, the institutionalised, patients with chronic abdominal pain, those with malabsorption syndromes, and food faddists
Inspection of his oral cavity displayed poor hygiene with gingival bleeding (Fig. 1). Examination of his extremities revealed multiple purpura, large ecchymoses, as well as tense brawny oedema on his right medial thigh (Fig. 2) and right calf (Fig. 3), in addition to haemosiderin pigmentation of the skin. On laying the patient prone, haematomas could be palpated in both the thigh and calf muscles of the affected leg.
Anaemia, bone pain, gingivitis, and swollen and bruised lower extremities marked with corkscrew hairs and follicular petechiae may be attributed to the lack of collagen present in the connective tissue of skin, gums, and bones which contain a greater concentration of collagen and are thus more susceptible to deficiencies.5 Death may result from weakened blood vessels consistently haemorrhaging, causing an anaemic state.
in list: MEDEDU
"right sided pneumothorax with complete right lung collapse. The right hemi-diaphragm is flattened, and the trachea is narrowed and bowed to the left, which suggests tension. There is some reticular shadowing in the upper zone of the left lung consistent with fibrosis"
Primary or spontaneous pneumothorax is more commonly seen in tall, thin males as well as in smokers.[1] Secondary pneumothorax is seen in a wide range of lung disease including pulmonary fibrosis, asbestosis, cystic fibrosis, chronic obstructive pulmonary disease, asthma, pneumonia, and lung cancer
important to assess for tension pneumothorax as it is imminently fatal and needs treatment as soon as it is identified with needle thoracostomy. predominant feature is hypoxia, and patients compensate with increased respiratory rate, increased contralateral chest wall expansion, and tachycardia. tracheal deviation, cyanosis, distended neck veins, and hypotension are normally late signs.
“safe triangle” created by the lateral border of pectoralis major, the anterior border of latissimus dorsi, and the horizontal level of the nipple.
in list: MEDEDU
numerous “rice grain” calcifications were seen throughout the body (with the exception of the hands and feet), with their long axes oriented in the plane of the muscle fibers
in list: MEDEDU
"Chest drains should be inserted in the “safe triangle” bordered by the posterior border of pectoralis major, the anterior border of latissimus dorsi, and the horizontal line of the nipple. As this chest drain was inserted to decompress a pneumothorax, the tip of the drain should have been directed superiorly towards the apex of the lung, where air tends to collect. To drain fluid, the chest drain tip should be directed inferiorly as gravity causes fluids to accumulate around the bases of the lungs. However, any tube position will still be effective at draining air or fluid, "
in list: MEDEDU
-
- Blunt or penetrating trauma, including Boehaave’s syndrome, where repeated intense vomiting or retching leads to oesophageal rupture and subcutaneous emphysema.[4] Surgical emphysema is a complication of surgery or investigative endoscopy to any of the air containing viscera
- Increased air pressure in the alveolar air spaces compared with the surrounding interstitium can lead to spontaneous rupture. This can occur during positive pressure ventilation, cardiopulmonary resuscitation, the Heimlich manoeuvre, or any situation where the intra-alveolar pressure is raised. The first reports of subcutaneous emphysema were in the 17th century by the midwife of the Queen of France, who observed it in women who had just been through labour[5]
- Gas forming organisms in the subcutaneous tissues such as Clostridium perfringens and Escherichia coli.
Air can enter the subcutaneous tissues by three main mechanisms[3]:
if my patient gave up the quest for the magic doctor, the magic treatment & bagan with me on a course towards wellness, it was because i had earned the right to tell them these things by virtue of the examination. something of importance had transpired in the exchange. rituals are all about transformation. of one individual coming to another & telling them things that they would not tell thier preacher or rabbi and then incredibly on top of that disrobing and allowing touch ...and if u shortchange that ritual by not undressing the patient, by listening with ur stethoscope on top of the nightgown, by not doing a complete exam, u have bypassed on the oppurtunity to seal the patient-physician relationship.
we seem to have forgotten with the explosion of knowledge we are lulled into inattention forgetting that the ritual is cathartic to physician, necessary for the patient- forgetting that the ritual has meaning & a singular message to convey to the patient : i will always always always be there. i will see u thr this. i will never abandon u. i will be with u thr the end
in list: MEDEDU
CFs that increase & lower probable asthma diagnosis:
yes -wheeze,breathlessness,atopic history/familiar,lowPEF,eosinophilia.
no -only cough,dizzy,tingling,voice,heart disease,normalPEF,smoking
in list: MEDEDU
in list: MEDEDU
-
Vitamin D deficiency has been associated with many chronic illnesses
-
The data warrant vitamin D supplementation in patients with severe COPD
diagnostic utility of pica symptoms associated with iron deficiency, as well as the evolution of its symptoms as a result of changing technology and culture. In the presence of pica, the physician is obligated to evaluate the patient for occult blood loss and iron deficiency.
in list: MEDEDU
-
craving for any unusual substance should compel clinicians to search for occult blood loss with secondary iron deficiency.
-
ice cubes (pagophagia), clay (geophagia), dried pasta (amylophagia), chalk, starch, paste, Kayexalate resin (resinphagia), tomatoes, lemons, cigarette butts, hair, lead, and laundry starch (for example, Argo out of the box) [1-7]. Although pica is most prominent in individuals with developmental disabilities, it has been observed in men and women of all ages and ethnicity, but is more prevalent among the lower socioeconomic classes [3,4]. Worldwide, 25% to 33% of all pica cases involve small children, 20% are pregnant women, and 10% to 15% are individuals with learning disabilities [8]. A small percentage of patients have iron deficiency anemia.
- 3 more annotation(s)...
first line :loperamide/laxative
solublt fibre rich : oats, lineseeds, ispaghula husk
ulcerative colitis : erythema nodosum red tender swellings on shins
coleiac disease : herpetiform dermatitis itchy vesicles on extensors
avoid senna [abd cramps] & resistant starch [processed or recooked food]
in list: MEDEDU
in list: MEDEDU
-
Potassium supplements (IV or Oral)
-
Extensive burns
- 17 more annotation(s)...
Selected Tags
Related Tags
Top Contributors
Highlighter, Sticky notes, Tagging, Groups and Network: integrated suite dramatically boosting research productivity. Learn more »
Join Diigo