September 2014 archive

Dr. Adeeb Zaer Hyponatremia: An Overview

If in extremis: Symptoms: Seizures, AMS, brain herniation, cerebral edema Treatment: 100cc 3% hypertonic saline over 20 minutes – reevaluate and repeat x 3 if necessary until neurologic signs are gone   How to evaluate Hyponatremia: 1st step – Determine which of the 3 kinds it is by calculating the serum Osms. Hypertonic – (serum …

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Dr. Anna Yaffee 52 in 52: Omeprazole in GI Bleed

Lau JY et al. 2007. Omeprazole before endoscopy in patients with gastrointestinal bleeding. NEJM. 356:1631-40.  Take home points: 638 patients with upper GI bleed undergoing endoscopy were randomized to receive omeprazole vs placebo. The patients who received omeprazole prior to endoscopy had less need for intervention during endoscopy, fewer actively bleeding ulcers. A higher percentage …

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Ankle Fractures!

Case Presentation:  Hx:  57 yo M p/w fall from 10 feet complaining of L ankle pain PE:  Primary survey intact.  Secondary survey for apparent intoxication and ankle deformity.  EFAST negative.  CxR, Pelvis XR and PAN Scan negative. Ankle Fractures Learning Points: 1)      Anatomy:  The ankle joint is made up of the medial malleolus (distal tibia), …

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