Alright, medfags of /b/. Let's test your knowledge. Yesterdays thread was pretty fun. Lets start with a classic.
A 61 year old caucasian male enters your ER complaining of severe chest pain.
He describes it as a sharp pain that radiates down his arm. The pain is a 10/10. He states the pain gets much worse when he breathes. He is sweating, has nausea, and is very anxious.
When you question him, he says he was recently discharged from the hospital 3 days ago from a heart attack he had 5 days ago. He states the pain is almost the exact same as when he had the heart attack. He states he had a stent placed in his circumflex artery. The procedure had no complications. Other than the recent MI, your patient has no significant past medical history.
Upon physical examination, you notice he is indeed sweating, has a slight fever, and is tachycardic. His respiration rate is low however, as it is very painful for him to breathe.
What do you do next on your physical examination?
>>712388906
Put finger in butt, jerk his peen
>>712389191
Anal wink reflex intact.
Penis is flaccid.
Nurse rips you away from the patient and you're escorted out of the ER by security.
Needless to say, your license is now in jeopardy and you don't have a job.
>>712388906
EKG
>>712389401
EKG shows diffuse ST elevation throughout.
Now what?
tell him he's gonna die and should probably fuck a trap before he dies cause that's my fetish.
>>712389621
Prinzmetal angina? I'm just studying to be a physiotherapist I'm trying
>>712389824
No one hears you say that.
>>712389851
Wrong. Perhaps there is more to be done on physical examination? Something more simple? What about asking him more questions about the pain?
>>712390020
Ask him is his pain stingy or numb I don't really know the phrases in english. Anyway gotta go man good luck.
>>712388906
1)Ask him of he's taken any medicine or dick pills.
2)start assistant with his ventilations @ a rate of 1 breath every 5-6 second
3)check for JVD/Edema or any CHF.
4) Give him aspirin and nitroglycerin.
5) Transport
>Barely started paramedic school. Any tips and advice would be appreciated.
>>712390272
No numbness or tingly feelings (i'm assuming thats what you meant)
>>712390321
1) He doesn't use dick pills
2) Your patient is fully awake, alert and oriented. Why try to breathe for him? You try anyways. He is noncompliant and when you convince him to allow you the pain is intolerable. You stop breathing for the patient.
3) No JVD or edema
4) Doesn't help the pain
5) Transport where? He's at the ER already.
THINK! What is something very simple that I didn't give you in the physical exam?
Remember OPQRST! What did I leave out?
I was a medicfag too. You're on the right track for what you do for something else, but this isn't what you're thinking.
Check breath sounds. Diagnose him with pneumonia. Admit to CCU
>>712390321
As a side note, you want to check vitals before you give nitro all willy-nilly or you'll bottom out his BP and you can kill the guy.
I'll give you vitals
Everything is normal except the tachycardia and RR being 8, slight fever of 99.8F. O2 sat is 99%.
>>712390827
Breath sounds are normal, but you hear something else... perhaps if you listen elsewhere?
Wrong diagnosis. Why admit a patient to CCU when you haven't even done a rather significant diagnostic screening?
>>712390616
>I'm not the greatest A-EMT
Also, my skills come to an end there. Don't even know what other drugs to give until I'm a paramedic, so transportation is the best I got. Don't know how to even read EKGs at the moment. But I'll try a bit more.
Onset?
Provocation?
>>712391220
That's fine. This is a learning exercise and you get to impress your class mates if you ever come across this curveball of a diagnosis. We didn't even learn this in detail in my paramedic program. You as a medic would treat it as you did, but in reality that is wrong.
Onset: he was watching the price is right relaxing when this suddenly came on. He feared the worst and called 911.
Provocation: you already know what makes it WORSE! What about better?
Tamponade?
Perychardites
>>712391393
To save the needless reply of you saying "What makes it better" I'll just tell you
He says, "Ya know, when I lean back and breath deeply it hurts a lot. But when i lean forward it makes it feel a whole lot better."
>>712391404
Nope. How can you confirm tamponade when you haven't even evaluated beck's triad?
>>712391482
The nurse sees you write that on the chart and is boggled by the spelling of the word.
Not to be a pain, but you need to go into a bit more detail as to why you think what it is.
>>712391500
So it's positional. Fuck, I remember something hell's Fucking important about that in Basic....
>It's not the heart of pain is positional.
I give b/ro. But sticking around to see what others got.
>>712391875
How about you listen to the heart to confirm if it is the heart or not?
You auscultate the heart and you can't hear any beats. You hear this strange rubbing sound, like the sound of two balloons rubbing against eachother.
Wat do?
Ekg, symptoms and medical history suggest acute pericarditis..transtoracic Eco of the heart and blood test for the troponines to be sure..
>>712388906
Watch Season 4, Episode 8 of House MD and $profit$
Light chest percussion to determine state of lung inflation.
If he were actually having an acute tachycardiac arrhythmic heart failure he wouldn't be talking to us, much less walking into the hospital.
>>712391990
Correct!
EKG was already run and showed evidence for acute pericarditis.
You do the echo and everything looks normal, but the pericardium is 4mm thick.
You run cardiac enzymes and the troponine is high... but why would you run just a troponine? He had a heart attack a few days ago and recently had a stent placed... The troponine would still be elevated. Perhaps you run a CK-MB instead? Really depends on what your hospital wants though.
BONUS POINTS! What's the actual name of this condition: acute pericarditis after an MI?
How do you treat it?
>>712392213
Normal.
He has no arrhythmias, only diffuse ST elevation. See >>712392391 for answer
>>712392391
Dressler syndrome
>>712392580
Good job. Google is mighty powerful isn't it? :^)
How do you treat it?
>>712392707
Not being a medic, it's a way of still playing the game.
The internet suggests over the counter medicine like Ibuprofen or Naproxen. If that doesn't work a prescription for Colchicine and Corticosteroids.
A 21 year old white female enters your urgent care complaining of an incredibly itchy rash on her face.
She states the rash has been there for about 2 days and its getting much, much worse. The rash does not ooze, no pustules, but has a flexural and symmetric appearance. When questioning her, she has a PMH of well controlled mild intermittent asthma but other than that, everything is normal.
She states that when she goes to take a shower, it makes the rash feels much better. However, when she gets out of the shower, the cold air from her apartment makes the rash much, much worse. The rash is much worse outside in the cold fall air.
She denies any known allergies.
Her vitals are completely normal.
What is most likely the cause of this rash??
>>712393106
Correct! You give a shit-ton of NSAIDS. You give colchicine if the event is shortly after the MI, as you do NOT give high dose NSAIDs to someone with a recent MI (within 48-72 hours).
Corticosteroids is a good treatment too.
For pain, you use codine. If they cannot take codine, too bad. The NSAIDs should treat it. Typically it resolves after one dosage of 2000mg acetaminophen.
Who would have thought that something that mimics a heart attack so well would be treated so easily?
>>712393294
drug-related exanthema?
>>712394210
Nope. But to rule that out you ask her if she has taken any medications lately. She denies taking any medications.
Think about WHEN this gets worse. Think about her past medical history.
>>712394311
Ask patient if she has started eating any new foods recently or bought any new clothes/pillow cover/ bed linen/or the like.
Sounds like atopy syndrome.
>>712394646
CORRECT! More specifically atopic dermatitis
Upon questioning, she states she bought this new face moisturizer and she didn't even think that that was the cause.
Treatment?
Alright paramedic fags, here's one for you.
You arrive on scene to a 44 year old black male who is complaining of chest pain.
He states he was working in his yard when this just suddenly happened. He states he's dizzy and fatigued. This has never happened before. He has no past medical history and denies taking drugs or any medications.
When you get his vitals, you see he has a heart rate of 190, pulse ox is 92%, but everything else is normal.
You run an EKG and you see normal P waves are a regularly regular rhythm, although the P waves are kinda tough to spot as they seem to mash together with the T wave.
What do you think is going on? What do you do first?
>>712394820
Identify and avoid irritants and allergens
>>712395571
Pretty much.
But the patient gets upset that you won't give her anything. It's very itchy and she didn't pay a copay for some advice. What drug do you give her?
What's the weather like? Could be heat stroke.
>>712395946
The riddle was already solved, my friend. >>712392391
>>712396056
There's a new one going.
>>712395666
Alright alright, chill cunt. She can get some topical corticosteroids.
>>712388906
are you preparing for the oral comity or something?
>>712395175
Could be either coronary artery disease, congestive heart failure or a heart attack. But I have no idea what to do with that EKG result :/
>>712396320
>corticosteroids
Regular steroids will do. Specifically Triamcinolone.
You can't blame her for getting upset. It's like when you go to the doctors office for a sore throat and they tell you to just wait it out. You don't go to the doctor and pay a copay to be told to just deal with it. Patients want drugs and this isn't an antibiotic so there's no harm in giving the cunt a topical steroid.
>>712396490
No. But lets go into more detail...
>coronary artery disease, congestive heart failure or a heart attack.
You auscultate the lungs and there is no sign of consolidation or crackles. There is no edema present. The EKG shows no ST elevation, depression, inverted T waves, or significant Q waves. Only a sinus rhythm at 190 beats per minute.
>>712396484
No. I'm just bored while studying and this helps me stay fresh. And it's fun.
>>712396566
But if it sounds more fancy they will like it better :o
>>712388906
>>712389621
Globeal ST changes? Which leads? (medicgfag here).
>>712390616
SpO2?
>>712396981
No ST changes. Normal axis. Shortened intervals due to high heart rate. All leads.
>>712397051
99%, but this riddle was solved.
>>712388906
do another op
A fib
>>712397506
Wrong. The P waves are normal.
>>712397494
see >>712395175
Come on, guys. You all are thinking too hard. There's an old saying in medicine: "If you hear hooves, don't think about Zebras."
>>712397192
Hm. My guess is the stent may have become dislodged traveling and getting stuck "further down the line".
This is a good one.
>>712397762
You're getting patients confused. This one is a 44 year old black male with no PMH. The first scenario was a 61 year old white male with a history of a stent 5 days ago.
I'll give you a hint. What is it called when you have a HR above 180 that is regularly regular with a normal P wave before every QRS?
1st degree heart block
Hes in tachycardia! This is serious.
>>712397927
A 1st degree heart block would not be visible with this high of a heart rate as the P wave would most likely be completely covered by the T wave. You can see the P wave in this one.
Also, as stated >>712397192, the intervals are shortened not lengthened
>>712398020
Well duh. What's the name of this kind of tachycardia?
tongue doot doot to the ass-pipe
exercise-induced tachycardia
>>712398192
You have made better decisions in your career and your partner reports the incident. You have gots lots of 'esplainin to do
>>712398301
Yes... this is tachycardia... but what type is it? This matters because you treat this differently than regular old tachycardia.
>>712395175
what's his work of breathing like?
what do his lungs sound like upon auscultation?
Pain score, pain description, any referd pain?
Blood pressure?
I like these threads keeps me thinking
>>712398506
disregard this, I'm very far behind
Lets hang a labetalol drip and see if it does anything.
>>712398506
Breathing okay.
Normal. No crackles, wheezes, ronchi, or evidence of consolidation.
4/10 pain. 10/10 is when he broke his pinky toe slamming it into the corner if his bed-post. The pain feels like a tightness. No referred pain.
BP is normal 120/80.
>>712398425
Is it supraventricular tachycardia? Does a vagal manoeuvre do anything to help?
>>712398596
Your protocols don't allow you to carry labetalol because your medical director is a paranoid faggot.
COME ON, GUYS! Don't think so hard about this! Don't make me give you the answer.
>>712398811
There we go!
You have your patient preform a vagal maneuver and it seems to slightly decrease the HR to about 160. However, once he stops, it kicks back up to the 190s.
Remember, your patient is symptomatic. While I wouldn't fault anyone for trying a vagal maneuver, there is something else I would do to treat this.
PAC, premature atrial complexes
>>712398939
The P waves are normal, so this is not correct.
>>712398914
is it adenosine?
I'm only a second year so I'm really just stabbing in the dark
>>712399084
How about Edison medicine before you chemically stop the guy's heart outside of an ER setting?
Also, I'll be hard pressed to find a rig that carries adenosine.
>>712398160
I'll take a guess: Supraventricular Tachycardia? I've been sitting and looking at ACG charts to figure this out ;_;
>>712399245
Correct! See >>712398914
>>712398811
Fuck didn't see this
>>712399221
oh, you mean pacing right?
I think intensive care paramedics carry adenosine in my country (Australia).
>>712399476
>pacing
Not really... there is another type of thing you wanna do.
While you ponder this, another rig shows up. You happen to be manning the transport rig. They load up your patient while you stand there pondering what to do. You tell your EMT to go lights and sirens to the ER. You have 3 minutes until arrival.
Wat do?
DDX
GO
I'm such a fucking slut, I'm gonna go weep about my incurable disease, lol.
I'm a dumb nigger from the hood, yet I somehow became a doctor.
>>712399659
Would Amiodarone do anything? Should probably give O2 as well.
I'm really uncertain.
>>712400482
How about you help a brotha out and treat this nigger with 190 HR?
I'm handsome and have daddy issues.
But my accent gets me all the pussy
>>712400543
Amiodarone is for ventricular tachycardias, not atrial based.
Your EMT yells from the front, "HEY, DUMBASS! HOW ABOUT YOU CARDIOVERT AT 190J!"
You do so and the SVT goes away! Only briefly though.
You pull into the ER and the ER staff is SO impressed with your preformance that they name you honorary doctor. The cute nurse says she'll suck your dick if you treat this guy.
You're now an ER doctor and you need to treat this guy with SVT. Wat do?
Thank you for calling Apple customer support.
Also I'm dead, lmao.
Start your Ca+ channel blockers and beta blockers.
Titrate.
Consider shock therapy
>>712388906
No green text on mobile.
38 m
Wake up middle of the night violently nauseous
Tremendous headache
Somehow fall back asleep
Wake up, head still hurts, vision is fucked up. Sporadic confusion, seeing shit, shadow masses floating through the room etc
Only major previous health issues was Venus thrombosis (sp?), years earlier, life 15 yrs.
>>712400899
hypertensive crisis
>>712400899
Do neurological exam.
Do fundoscopic exam to rule out retinal detachment.
Ask about trauma.
Ask how long ago did this happen?
Get CT scan.
Most likely see the old stroke and pity the fool for going back to sleep and missing the 3 (or 4 hour depending on your source) hour window.
Treat with admission, heparin bridge into warfarin, and rehab.
I fantasize of being pegged by House's vein cane.
>>712388906
he's too far gone
slap some ointment on his back, tell him to take an aspirin, and prepare the sacrificial altar
Maybe CT of the head too.
Hydrocephalus or Cerebral edema
>>712400877
I'm looking for adenosine.
Now what if this was afib w/ RVR? Do you still treat with adenosine?
>>712400899
Oh, and he could just be hung over or a diabetic. I'd ask that too.
>>712401208
Winrar. It was a stroke, hit both occipital lobes, got o piece of the thalamus and post medial temporal lobe. On warfarin now, headaches stopped but prescribed xanax for sleep and green to remain chill.
Took me 3 days to get to the hospital I was so confused. Therapy helped identify where the blind spots are so I kind of learned how to see around them. Doesn't help that sometimes I cannot understand what I am looking at, especially abstract or super dynamic things, like the sky, or trying to watch tv...just can't keep up anymore. I love audio books.
>>712388906
Go to Mexico so you can put down some beaner and use his heart as a replacement. Walls will keep the organ donations at an appropriate manner.
>>712388906
wish I could participate :( this seems fun.
>>712401767
...how are you writing so quickly on your mobile? Voice to text? How are you reading what I'm typing?? TEXT TO AUDIO?!
GODDAMN TECHNOLOGY IS NEAT
>>712401912
I can teases out only exactly what I am looking at. So yes, I can see well enough to read, Altho sometimes letters switch around, or look the same. 3s look like 8s, vice versa. And using swipe. Just like using a keyboard it's become pretty easy muscle memory exercise, don't need to see to type on the keyboard, phone is a little harder but I can manage
Okay, so /b/ sucks ass at SVT. That's fine. We're here to learn.
NEXT CASE!
A 70 year old caucasian male enters your urgent care complaining about fatigue with activity.
He relates that he tries to stay very healthy due to his bad family history with hyperlipidemia. He runs daily about 5 miles. However lately he's only been able to run about 2 miles until he becomes too fatigued.
Upon physical examination, you auscultate a midsystolic murmur heart at the right sternal border. Everything else is normal.
Vital signs are completely normal.
What do?
>>712402214
Sucks. Why weren't you put on a blood thinner after your first clot? Did you get a filter placed?
>>712400797
Sinustachycardia and you wanna fry the patient? Is this what you learn in the states? Jesus fuck no wonder docs get sued all the fucking time.
>>712393294
Lupus
(21 yr old white female was the clue)
>>712402412
I was put on warfarin after the first incident and was on it for fucking years, but after the first event I had zero symptoms. Sorta gave up on it cause it had been so long and warfarin is a bitch with all the checking. No loss of function after the first event, after making sure it wasn't anything vascular they sort of shrugged their shoulders stating is maybe genetic. (Am adopted)
So, same situation as before Altho I'll be on the thinners tull I die I guess. I just don't wanna lose anymore function, I would much prefer death.
>>712402819
>sinus tachycardia
>HR 190
>cardioversion is "frying the patient"
Begone, CNA. Your opinion is shit.
>>712402936
>After being put on warfarin I had zero symptoms..
that's pretty much the idea
>>712403032
and yours is wrong and dangerous
>>712403200
You'd be surprised how many people quit their medications because "I'm better now so I didn't think I needed it."
>>712402283
Echo and EKG to evaluate
>>712403295
A symptomatic patient with a HR of 190 is deadly, CNA. I know they don't teach you that at the nursing home, but cardioversion has been the mainstay treatment of SVT for decades.
>>712403411
You do an EKG and it shows left ventricular hypertrophy.
The echo shows the same thing, but also shows a stiffened aortic valve.
Wat do?
>>712402283
Charge his phone battery, extract it, hook up some leads with normal scotch tape (budget cuts), and jab the leads into his thumbs to get around the skin resistance.
>>712403536
Sounds like aortic stenosis. Surgical referral. This is druggist from last night btw
>>712403200
Fuck it was years. .. 5 or 6 idk. Then when another ten years with zero problems. Till one night, outta nowhere. Either way well played, nice to see there are legit med fags here
>>712403442
No idea what the fuck cna is but whatevs, chemical cardioversion comes before electric cardioversion. But my guess is you are not allowed to use that kind of medication and paddles are fun. You're a complete moron.
>>712403812
Oh hey pharmfag.
Correct!
What should you tell your patient to not do until after the surgery and he recovers?
>>712403934
The scenario starts with you being a paramedic... Then the scenario went to you being the doctor in the ER when you have the drug.
r u srs, CNA? I think Mr. Jenkins in room 308 shit himself. Go clean him up while the real medfags talk.
>>712403862
Nobody can tell you if you will ever have problems but your risk is elevated and for that reason you were put on blood thinners. In many cases it is a lifelong medication, yes it is utter shit but better then getting another clot wherever.
>>712403995
I'm guessing exercise?
>>712404166
You're a paramedic? Ok, get the patient to the ER. done
Now the doc. You don't fucking use paddles before using medication.
You little dumbfuck aren't even trustworthy enough to push a patient around in a wheelchair. Go back to wanking over wiki
>>712403934
cna = certified nurses assistant
they only get about 2 weeks of training, sometimes 6 months depending on the method used to get the license
theyre only taught how to wipe asses,position, and feed
the other guys fucking with you, because most nurses fucking hate cna's
A 45 year old black male comes into your clinic complaining of abdominal pain.
He tells you it's been going on for a while now and that it is moreso in the right upper quadrant. The pain doesn't radiate. He also states he has been a bit bloated since the pain started, but the bloating is getting much worse.
You being a physical examination and you notice his belly is really distended. When you push on it, it seems to have the consistency of a thick balloon filled with water. There is slight tenderness to the right upper quadrant. The rest of the examination is normal.
The patient tells you he is a 2 pack a day smoker for 30 years and drinks a 1/5 of vodka every day.
Vitals are completely normal.
Wat do?
>>712404522
cirrhosis
>>712404284
Yep. If you exercise too much with aortic stenosis, you can end up causing an electrical disturbance in the atrium and you can throw your patient into A fib. In rarer cases, the electrical current in the ventricle will be thrown off and you can go into v-tach or vfib. Either way, tell him to relax.
>>712404652
Pretty obvious one, but correct!
Wat do about he pain? What about the stomach swelling?
>>712404196
>lifelong medication
Yeah that's where I'm at with it now and accept it. Whatever it takes to keep it from happening again.
>>712388906
GIVE NITRO
>>712404511
https://acls-algorithms.com/rhythms/supraventricular-tachycardia/
>Unstable patients with SVT and a pulse are always treated with cardioversion.
Kill yourself, CNA.
>>712404522
Ascites from liver damage d/t alcohol abuse. Anicteric? CMP bili etcfor assessment and liver enzymes. Could consider echo to evaluate liver.
>>712404514
My guess was along those lines.
Really bad line of thinking on his part though, everybody in a hospital is important. From the docs to the cleaning staff. Well whatever he's going to be he'll have a lot of fun with this kind of attitude.
>>712404522
Pancreas, move on
pain will dissolve after management of the bloating.
bloating-wise, dialysis, beta blockers, diuretics, osmotic laxatives, lactulose and Xifaxin comes to mind
>>712404894
not that guy, but what made you so bitter towards the lowly CNA?
A concerned mother brings her 4 year old caucasian son into your clinic claiming he's been tired lately.
She states he just hasn't been acting the same for the past 2 days. She says this happened after she picked him up from the day care. She says he feels warm to the touch and has been cranky.
You do a physical examination and notice that when the kid winces in pain when you bend his head forward. He's warm to the touch. Everything else is normal.
Kid has a fever of 103F, tachycardia, but otherwise normal.
What's going on? Be specific!
>>712404747
Gently diurese with loop diuretic, maintain on spironolactone 100mg daily. Light narcotics for pain
>>712405153
It is not a case of not liking CNAs. It is the fact that someone was being ignorant, and the CNA is the least experienced of the medical field.
>>712404894
>When you get his vitals, you see he has a heart rate of 190, pulse ox is 92%, but everything else is normal.
>BP is normal 120/80.
>unstable...
Never seen a real patient in your life have you moron?
>>712391393
Oh Oh I get it!
It's like that commercial that played on the radio.
Fucker thinks he's got a heart attack, when it turns out he just has a huge fart. The doctor pushes it out of him, and he goes home.
Either that or a huge shit. Sometimes I get a little feverish when I've got a huge shit.
>>712405153
It's just a way to assert myself over morons who have no idea what they're talking about. Don't take it personally. I love CNAs. I'd hate to do what they do. This CNA in particular is that big black woman who don't need no man and is always sassy and argues with everyone.
>>712405258
Hand-foot-mouth disease
>>712405351
nah that's you
>>712405358
see >>712395175
>dizzy and fatigued
>chest pain
Last reply, fam. Just off yourself.
>>712405258
Otitis media? Examine ear for infection
>>712405026
>Pancreas, move on
No.
>>712404938
Good!
>>712405261
Good start. Lets say it doesn't work. Wat do?
>>712405258
Meningitis
Prepare to nuke from fucking orbit
>>712405443
No
>>712405527
You inspect the ears and palpate the auricle, tragus, and mastoid. No tenderness. Ears look clear.
>>712405631
Correct! But how can you be sure this is a very bad type of meningitis or a not-so-bad type?
>>712405759
bend at thigh manuuver
>>712402412
I wish that would've happened to my mom after we were told she got a blood clot 3 weeks ago.. turned out it was an aneurysm and there was nothing to be done.. died in under 12 hours.
>>712405625
Which doesn't work , diuretics or narcotics?
Daily lactulose should help bloating.
If diuretics don't work could tap him and give him abx to prevent SBP
>>712405841
Meeeh... That doesn't really differentiate what's going on...
I'll give you a hint, House MD would love for this to happen.
>>712405512
As I said, you've never seen a real patient. If every patient with dizzyness and fatigue was unstable then every motherfucker in an ER would be. But keep feeling superior even though you are the lowest light there is, even your colleagues will talk behind your back and ask what kind of dumb shit the moron has yet again done.
>>712405936
Diuretics.
>could tap him
Correct! Break the barrel and get that fluid out of him.
>>712405153
im not taking it personally
why should i?
i was just wondering why you kept using CNA as an insult
>fucking niggers are the worst
>amirite,png
>>712405950
cerebral spinal tap
Great, I have the highest skilled medical proffessionals on /b/ here.
Teenage girl comes in to you, complaining about intense pain in her knee. She woke up a few days ago, stretched, and felt her hip and knee joints 'crack' before the pain set in immediately. The pain in her hips and one knee dissipated after a few days, but one knee still has intense pain.
She notes she was kneeling on an uncomfortable floor a lot the day before symptoms, and has nothing else to add besides noting the pain in her knee is strong in all positions.
Being a teenager in 2016, she uses the internet and self-diagnoses as "Preacher's Knee."
>>712406176
Correct! What do you want to do first though to reduce the unlikely chance of herniating the disc?
Results come back. It's bacterial... WAT DO??
>>712406317
Good case. I genuinely don't know.
>>712406331
tell CNA to perform spinal tap with patient lying on side, curled in fetal position.
Bacterial? hit the 4 y/o with linezolid iv
>>712406520
Well I was looking for CT scan. It's always better to be safe than sorry.
Correct on the treatment though! Also pray to god you didn't catch it.
>>712406317
fibromyalgia
>>712406317
People around here say shit like "pinched nerve."
I think it's Osgood-Schlatter's with no other reason to think that.
He just ate taco bell.. Needs to fart really bad.
>>712406760
To diagnose, touch the tibial tubercule to see if it's tender as dry-fucked cunt.
>>712406760
possible if she's very active in sports (mostly associated with teenage boys though), meniscal damage possible should be tested and an MRI might also help
A 36 year old caucasian male comes into your clinic complaining of abdominal pain.
He states the pain is diffuse and radiates to the back. He says the pain just suddenly happened when he was watching TV. Nothing seems to make it worse, but the fetal position makes it better. This has been going on for about 30 minutes.
The patient is in intense pain and is noncompliant with most of your physical exam. You ask your patient to sit up and you bump is back. This makes the pain intolerable.
Vital signs are normal.
What do?
>>712407367
peritonitis
>>712407530
Nope. Wanna run some tests?
>>712407367
ct scan with contrast
>>712407703
>>712407710
KUB
blood culture
stool for OB
>>712407710
Results show a 5mm calculus lodged in the right ureter.
>>712407806
KUB you can see a density in the right ureter.
Blood cultures sent.
Stool sent.
>>712407225
>>712407260
>>712406760
>>712406708
>>712406495
Thanks gents. It's my cousin from a few states over. Her mother is a nurse and won't take her to the doctor.
>>712408030
fill him with fluids and furosemid then watch his kidney explode
>>712408030
>
KUB you can see a density in the right ureter.
kidney stone pain.
Use U/S to destroy the stone depending on type. Start a nephron drain
>>712408030
try to separate the equations
integrate
>>712406760
That has to do with the knees lol i had that
>>712408198
generally diagnosis without seeing a patient are just guesses, so yea she should see a doctor
>>712408347
i lol'd
>>712408359
This isn't that big of a kidney stone... What do you want to do instead?
>>712408582
Surgical consult to remove the stone.
or,
start iv hydration/ drink more fluids and pray it'll flush out the stone.
>>712408582
Isn't the old/cheap method to give him opiates for the pain, fluid to flush, and let him pass it?
>>712408797
How about flomax and and toradol with 500ml NS?
Honestly, you can even send this patient home and give them those drugs and have him sit in the bathtub and drink a ton of water to make it pass.
Once it gets to about 7mm or more is when you want to consider procedures, but you should at least try flomax and toradol for pain.
>>712408840
Use to be. Flomax relaxes the ureters and allows them to dilate. This allows the kidney stone to be pushed out.
For some reason, toradol is the best pain killer for kidney stones. I believe it has to do with dilating the ureter a bit more and reversing the inflammation that the stone caused.
But tbqh, I wouldn't have too much of an issue sending this patient home with some NSAIDs and tell him under the table to drink a shit load of beer to make him pee it out.
Someone has had a surgical stomach removal after an accident, and a short bout of pancreatitis.
Now they poop once a week, and it makes them feel like they'll die each time.
Besides prune juice, wat do?
>>712409431
colace 100mg po q d
>>712409285
When did we get all of these fancy new drugs? I thought Naproxen, Ibuprofen, and Acetaminophen were the only NSAIDS out there.
>>712409596
Acetaminophen is not an NSAID.
We've had these drugs for a while. But you're right. The world of pharmacy is rapidly changing.
>>712409773
for the better, or worse?
>>712409845
Better for patients.
Worse because I have to fucking learn them and it's a pain in the ass remembering all this shit.
>>712409920
Why are all of them so stupidly fucking specific?
Why can't you just use general-purpose ones?
>>712409516
add mag citrate and aluminum hydroxide enemas
>>712410169
Pharma/b/ro might be able to answer that question better than I can (if he's still here).
Every single drug you take has a side effect. Every single drug you take will affect your body in a certain way. If you have a very specific issue, you typically want to affect less body systems. The broader acting drugs affect more of the body typically speaking.
The more specific the drug is, the more specific the side effects. The more specific the side effects, the easier we can prevent/treat them.
The more broad the drug is, the more... well, you get the point.
At the end of the day you want to affect as little of the body as possible because the body does a pretty damn good job at making itself work properly.
That's the simplest way I can put it.
