The untold reality of morning rounds.
Kawasaki Disease
Diagnostic criteria = Burn + 4/5 of CRASH Child 6m-5y: think Kawasaki!
Congenital Infections in Drawings!
Medicowesome is in the house
Go and check the YouTube channel - https://www.youtube.com/channel/UCIXqJTsNCFaHcBOMT75T3PA/videos.
One of the unique ones out there. Original content!
How to remember the cardinal features of congenital CMV and Toxoplasmosis infections?
(You have to watch this one - https://www.youtube.com/watch?v=BRg_dT2T80k)
Anti-epileptics/Anti-convulsants Made Incredibly Easy
TREATMENT STRATEGIES:
- Start therapy after the second seizure; first ONLY if recurrence is high = MRI abnormal, EEG abnormal, or status epilepticus.
- Monotherapy until seizures are controlled.
- If failed: titrate up to maximum tolerated dose --> shift to alternative drug --> use drug combination --> VNS, DBS.
- Full drug therapy for 2 – 3 years after the last fit.
- Gradual withdrawal over at least 6 months.
Rx Profile:
(Drawings are courtesy of @mynotes4usmle)
Carbamazepine
- Mainly for generalized tonic-clonic seizures
- Trigeminal neuralgia
- Bipolar disorders (with depressive predomince) - mood stabelizier
- NEVER in abscence seizures
- SE:
Lamotrigine
- Safer profile, with minimal interactions.
- Bipolar disorders (with depressive predominance) - mood stabilizer
- SE: maculopapular rash; SJS
Topiramate
- Broad spectrum anti-seizure; used in migraine.
- SE of TopIRamate: enzyme Inhibitor + Renal stones.
Epilepsy & Pregnancy:
- Non-enzyme-inducing AEDS have no effect on the pill. Enzyme inhibitors prolong the half life of OCP (=Valproate) so better for birth control , and vice versa.
- Most of AEDs are teratogenic; Category D
- Therapy not stopped; uncontrolled seizure is risky to fetus & mother. Give lowest effective dose.
- Avoid phenytoin, valproate and barbiturates (use Lamotrigine)
- Most AEDs cause folate deficiency …. Folic acid (prior to or early in conception)
- Most AEDs are competitive inhibitors of vit. K-dependent clotting factor: Vit. K to mother 10 days before labor & to newborn.
- Most except carbamazepine and valproate are present in breast milk. Lamotrigine is safe on infants.
Status Epilepticus:
- WHAT? Seizures lasting for >30min, OR repeated seizures without intervening consciousness.
- Things to be done:
- Bedside glucose, the following tests can be done once Rx has started: lab glucose, ABG, U&E, Ca2+, FBC, ECG.
- Consider anticonvulsant levels, toxicology screen, LP, cultures, EEG, CT, CO level.
- Pulse oximetry, cardiac monitor.
- How to treat?
THE END
AntiTB Mnemonics
So my first semi-original post of mnemonics. Yay!! I never thought it would be this much fun.
Let me know if there is any correction/additions you think of.
Shout out to the following resources of awesomeness:
- BaroneMnemonic
- medical-institution
To a fellow medblr @mynotes4usmle, who pretty much redefined the concept of: we’re all in this together.
The untold truth about Fistulas :)
Let’s get serious for a minute.
What’s a fistula?
An abnormal communication between two epithelialized surfaces.
What’s the most famous examples you know of? perianal fistulas, arteriovenous fistulas, etc.
Normally, fistulas close spontaneously unless FRIENDS come in the way.
F.R.I.E.N.D.S are factors interfering with the natural closure of fistulas.
F Foreign body
R Radiation
I Inflammation/infection
E Epithelialization
N Neoplasm
D Distance (the shorter the worse), Drainage (the lower the output the better, 500mL/d is your cut value), Distal obstruction, Drugs (chemotherapy)
S Steroids
Got it?
med-wonderland reblogged
Secrets of Great Doctors
[ As seen everyday through the eyes of Nurses]
1. A doctor who, above all, respects the inherent worth and dignity of every patient regardless of socioeconomic status, disease, race, ethnicity, or personal judgments as imparted by another health care professional.
2. The doctors who do not dismiss the concerns, or instinct of a nurse, nursing student, or med student.
3. A doctor who isn’t afraid to admit when he/she is wrong; to the patient, the nurse or any student in their charge - and a beautiful sincerity in apology without blaming others for what they are responsible and accountable for.
4. A physician who respects students of all descriptions - med students, nursing students, PA students - perhaps likely remembering the beginning of their own journey. One that respects the inherent worth of all his/her colleagues from the housekeeper to the cafeteria worker.
5. A doctor who actually does their assessments, not just standing by the door, observing and charting inaccuracies. Moreover, there is something memorable about the ones who not only anticipate quality of care, but the ones who take the time to listen intently to, and care for their patients.
6. A doctor who doesn’t embarrass, or make examples of a nurse, resident, or med student during rounds when they answer a question incorrectly - and actually takes the time to explain so there’s learning involved. (Not to mention respect of their knowledge and patience).
7. Physicians who understand that there’s sometimes a time to let go, despite any heroic measures, there’s insight of what would be best for the patient, over relentless interventions.
8. A doctor who doesn’t come out of a patient’s room to ask a nurse/nursing assistant to put a nasal cannula on, fetch a glass of water, blanket or any basic items that a patient is also probably secretly wondering why they have to go get someone else to help me with something so simple; and while some of the more time consuming tasks are not expected - it’s always so very appreciated when one takes the time to assist a patient with positioning, or cleaning.
9. Doctors who stand up for nurses to the Nursing Supervisors, or one who defends the nurses when a patient or family member is being disrespectful.
10. A doctor who on any given day, amid the overwhelming stress, chaos or fear will always find a little humor, and never lose sight of why they chose to honor their oath of care.