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 …
Category: FEN/GI
Aug 01
RUQ Pain
Presentation: 46 yo M with 2 day hx of RUQ pain and n/v. Taking Tylenol for pain. PE: VS NL, appears distressed, + TTP in RUQ and epigastrium Workup: RUQ US: showing sludge in gall bladder, no stones, no pericholecystic fluid and the wall was not thickened. However, the common bile duct was dilated to 8mm …
Jul 11
Anal Fissures!
Exciting topic: Anal Fissures! Definition: Tear in the anorectal dermal tissue, usually at the posterior “6 o’clock” position where the anorectal muscle come together Hx: Patient presents with sudden onset rectal pain with small amount of bleeding PE: Usually posterior tears, but if tear occurs at any other position consider comorbid conditions such as IBD …
Jun 13
DKA and HHS
HHS v. DKA: 1) What’s the difference? HHS patients, as opposed to DKA patients, usually have some residual circulating insulin that prevents secretion of glucagon and glucocorticoids. These hormones are responsible for the breakdown of free fatty acids and the formation of ketone bodies seen in DKA. 2) What about this patients …