Wednesday, 20 July 2016

Secretoneurin levels provide incremental information to established risk indices for the prediction of mortality and shock in critically ill patients with severe infections

Seizure may be a presenting sign in 20% to 50% of cases of Hib meningitis (less in other etiologies), but neck stiffness is uncommon.

You may think you don't have memories, but often as you begin to talk about what you do remember, there emerges a constellation of feelings, reactions and recollections that add up to substantial information

You may think you don't have memories, but often as you begin to talk about what you do remember, there emerges a constellation of feelings, reactions and recollections that add up to substantial information

I haven't failed. I've found 10,000 ways that don't work. ~ Thomas Edison

The greatest delusion that we all suffer with, is that we all believe that we have time.

DM2 PUFA significantly lowered glucose, HbA1c, and fasting insulin.PUFA SOURCE EGGS

"The actions of men are the best interpreters of their thoughts." -- James Joyce

"The actions of men are the best interpreters of their thoughts."

-- James Joyce

ADENOVIRAL INF NPT PCR

Species identification and viral burden may assist in interpretation of a positive HAdV result. Low viral burden with HAdV-C may be consistent with incidental detection.

The actions of men are the best interpreters of their thoughts." -- James Joyce

The actions of men are the best interpreters of their thoughts."

-- James Joyce

Genes can have up to 80 percent influence on students’ academic performance

MY RULE OF 60 , IF CRP OVER 60 ADMIT

CENTRAL LINE- HEPARIN OR SALINE

The "Stockholm tradition" has been: hospitals on the northern side adds heparin, whereas those on the south side don't use heparin. I changed employer in 2014 and is now with a non-heparin NICU

Since I came from a pro-heparin hospital I was a bit skeptical about not adding heparin to our low-flow saline in central catheters/lines.

UDALL "We have, I fear, confused power with greatness."

"We have, I fear, confused power with greatness."

UNAMUNO "Art distills sensations and embodies it with enhanced meaning."

"Art distills sensations and embodies it with enhanced meaning."

scott "Success - keeping your mind awake and your desire asleep."

"Success - keeping your mind awake and your desire asleep."

CAST FRACTURE

A toddler’s fracture is also known as a “Childhood Accidental Spiral Tibial (CAST)” fracture. They are the same thing. In a Toddler’s fracture:
Fracture is not displaced.
Spiral or oblique pattern.
Involves distal half to distal third of the tibia.

Fractures of the more proximal tibia may be suspicious for non-accidental trauma.

Often as a result of minor mechanism, many times with a rotational component.
Initial x-rays commonly do not show evidence of Toddler’s Fracture (13-43%).
While there is no evidence in the literature to suggest that casting speeds healing, it does decrease the risk of displacement.

Clinicians resuscitated extremely preterm infants without a detectable heartbeat, even at 22 weeks of gestation. No infant survived without resuscitation or if their heartbeat was not regained by five minutes.

HIE X Mg

In infants with hypoxic-ischaemic encephalopathy, predominant patterns of brain injury moderated the association between lowest plasma magnesium in the first three days of life and impaired brain metabolism.

Failure is only the opportunity to begin again, this time more wisely. - Anonymous

In term appropriate for age healthy newborns within the first few hours of life, 'normal' blood glucose concentrations can range between 1.4 mmol/L and 6.2 mmol/L, but by about 72 h of life they reach values of 3.5–5.5 mmol/L.

In term appropriate for age healthy newborns within the first few hours of life, 'normal' blood glucose concentrations can range between 1.4 mmol/L and 6.2 mmol/L, but by about 72 h of life they reach values of 3.5–5.5 mmol/L.

Eating more whole grains linked with lower mortality rates

MX

Praise in public, criticise in private

Make decisions – don’t be indecisive

Concentrate on your strengths and let others cover your weaknesses

Make people feel good about themselves

If you don’t ask you don’t get

BRONCH X APNEA IF PREM,UNDER 3 MO OR BACKGROUND CHRONIC ILLNESS

Wednesday, 13 July 2016

Exulansis: The tendency to give up trying to talk about an experience because people are unable to relate to it.

Exulansis: The tendency to give up trying to talk about an experience because people are unable to relate to it.

Lachesism: The desire to be struck by disaster – to survive a plane crash, or to lose everything in a fire.

Lachesism: The desire to be struck by disaster – to survive a plane crash, or to lose everything in a fire.

Kuebiko: A state of exhaustion inspired by acts of senseless violence.

Kuebiko: A state of exhaustion inspired by acts of senseless violence.

Ellipsism: A sadness that you’ll never be able to know how history will turn out.

Ellipsism: A sadness that you’ll never be able to know how history will turn out.

Anecdoche: A conversation in which everyone is talking, but nobody is listening

Anecdoche: A conversation in which everyone is talking, but nobody is listening

Chrysalism: The amniotic tranquility of being indoors during a thunderstorm.

Chrysalism: The amniotic tranquility of being indoors during a thunderstorm.

Jouska: A hypothetical conversation that you compulsively play out in your head.

Jouska: A hypothetical conversation that you compulsively play out in your head.

Mauerbauertraurigkeit: The inexplicable urge to push people away, even close friends who you really like

Kenopsia: The eerie, forlorn atmosphere of a place that is usually bustling with people but is now abandoned and quiet.

Kenopsia: The eerie, forlorn atmosphere of a place that is usually bustling with people but is now abandoned and quiet.

Rubatosis: The unsettling awareness of your own heartbeat

Énouement: The bittersweetness of having arrived in the future, seeing how things turn out, but not being able to tell your past self.

Énouement: The bittersweetness of having arrived in the future, seeing how things turn out, but not being able to tell your past self.

Monachopsis: The subtle but persistent feeling of being out of place.

Monachopsis: The subtle but persistent feeling of being out of place.

Opia: The ambiguous intensity of Looking someone in the eye, which can feel simultaneously invasive and vulnerable.

Opia: The ambiguous intensity of Looking someone in the eye, which can feel simultaneously invasive and vulnerable.

Sonder: The realization that each passerby has a life as vivid and complex as your own.

Sonder: The realization that each passerby has a life as vivid and complex as your own.

Craniosynostosis is an uncommon disorder of childhood affecting 4/10 000 children

ROSEOLA X DRUG RASH

Roseola: fever with occipital lymphadenopathy; then rapid defervescence corresponding with
appearance of a red, maculopapular rash over trunk and arms lasting 1–2 days.
Note: Many children are started on antibiotics for the fever and then misdiagnosed as having
a drug reaction when the rash appears.

PEPTIC ESOPHAGITIS

• Peptic oesophagitis: this is usually correlated with an increase in the number and
duration of refl ux episodes. Blood-fl ecked vomitus and anaemia may result.

HYPERTHYROID- Six times as many girls are affected as boys, most commonly during puberty.

Six times as many girls are affected as boys, most commonly
during puberty.

• With severe burns to the face, consider early endotracheal intubation

Irritability in children with profound disability

Irritability in children with profound disability

Irritability in children can present the clinician with diagnostic uncertainty, amplifi ed in
those patients with diffi culties in communication or complex medical illness. In children with
severe cerebral palsy the following differentials should be considered:
• Muscle spasm.
• Seizure.
• Pain:
– Consider all the usual sites of infection (e.g. otitis media, urinary tract, throat, sinusitis,
respiratory tract and skin).
– Gastro-oesophageal refl ux.
– Dental abscess/caries.
– Corneal abrasion/foreign body in the eye.
– Pancreatitis.
– Renal colic.
– Surgical – appendicitis, intussusception, torted testes.
– Severe constipation.
– Subluxing or dislocated hips.
– Fractures – accidental or infl icted.
– Side effects of medication e.g. anticonvulsants.
– Gynaecological.
– Sleep deprivation (associated with pain and spasm).
– Increased intracranial pressure (many children have VP shunts).

PROPER Hypernatraemia (serum Na+ >154 mmol/L)

Hypernatraemia (serum Na+ >154 mmol/L)

cannula

Dorsum of the non-dominant hand is preferred.
• Alternative sites include the anatomical snuffbox, volar aspect of the forearm, dorsum of
the foot, great saphenous vein or cubital fossa

Whatever technique is used, ensure that ventilation expands the chest adequately.

Whatever technique is used, ensure that ventilation expands the chest
adequately.

the road not taken

I shall be telling this with a sigh

Somewhere ages and ages hence:

Two roads diverged in a wood, and I—

I took the one less traveled by,

And that has made all the difference.

from Robert Frost – The Road Not Taken

Pomegranate finally reveals its powerful anti-aging secret urothelin a

Pomegranate finally reveals its powerful anti-aging secret

Wheresoever you go, go with all your heart. ~ Confucius

autisms sharpest form

Childhood disintegrative disorder, a rare and severe condition, rapidly melts away a child’s abilities

ED PDU STATEMENT OF ORIENTATION

Statements of orientation

One of the skills identified in physicians who had lower litigation risk was that they frequently used “statements of orientation” which, according to Levinson and colleague, are statements that “educat[e] patients about what to expect and the flow of a visit”.5 This helps create an outline for what the patient is going to experience during his ED stay. This is a doable skill that is easily implemented into an emergency medicine practice. When we take a few moments to explain, to the best of our ability, what the ED experience will likely look like to our patients, we may reduce fear and anxiety. If done correctly, this one simple communication skill can be the foundation on which we build the entire patient-physician relationship.

FLOW OF THE VISIT

ubiquity of headphones just another emblem of catastrophic social decline, edging us even deeper into narcissism and unsociability

Donaudampfschiffahrtsgesellschaftskapitän, which in English becomes four words: "Danube steamship company captain.

he average EM physician sees about 1.5-2.5 patients per hour

The average EM physician sees about 1.5-2.5 patients per hour6 , and research shows that only 28% of an EM physician’s time is spent on direct patient care.7 This means that during a busy shift, you only have about 6-7 minutes per patient. Often in times of peak flow, you could see more than 3 patients per hour, lowering your face-to-face time to only a few minutes per patient. An EM physician’s time is extremely limited, and if we slow down to spend more time with our patients, the waiting room fills up and administrators get restless.

Acknowledge That All Emotions Come From Within and That We Create Our Own Feelings

In primary care research, better interpersonal communication and increased time spent with patients are shown to decrease litigation risk

MEDICOLEGAL One of the main reasons patients seek legal recourse, however, is mis-communication, and not under-testing.2–4

One of the main reasons patients seek legal recourse, however, is mis-communication, and not under-testing.

causal effect of magnesium supplementation on lowering blood pressure in adults.

INTUSS Target sign shows layers of invaginated bowel

INTUSS Nylund et al saw an increased association with Salmonella, E. coli, Shigella, or Campylobacter

The idea of using capillary refill time as a surrogate for measuring shock or dehydration status

In 1947 Henry Beecher and colleagues proposed capillary refill time (CRT) as a means of determining shock state

DX UTI

children who have pain/crying passing urine, smelly urine, had a previous UTI, absence of severe cough, or severe illness is present. Three or more of these symptoms suggest it is worthwhile going to the effort of getting a urine sample. Surprisingly, fever was not a useful indicator for identifying children with UTI in primary care."

Pumping iron: Lighter weights just as effective as heavier weights to gain muscle, build strength

Most siblings of food allergic kids do not have food allergy

he inability to remember details, such as the location of objects, begins in early midlife (the 40s) and may be the result of a change in what information the brain focuses on during memory formation and retrieval, rather than a decline in brain function.

he inability to remember details, such as the location of objects, begins in early midlife (the 40s) and may be the result of a change in what information the brain focuses on during memory formation and retrieval, rather than a decline in brain function.

Travelers frequently report experiencing a significantly slower jet lag recovery after an eastward vs. westward flight.

Character traits, such as grit or desire to learn, have a heavy hand in academic success and are partially rooted in genetics, according to a psychology study at The University of Texas at Austin

Dieters tend to adopt the wrong strategies, often planning to ditch their favorite foods and replace them with less-desirable options, according to new research. Conversely, successful dieters focus on adding healthy foods -- foods that they actually like

Dieters tend to adopt the wrong strategies, often planning to ditch their favorite foods and replace them with less-desirable options, according to new research. Conversely, successful dieters focus on adding healthy foods -- foods that they actually like

Cinnamon may aid learning ability

Cinnamon is a delicious addition to toast, coffee and breakfast rolls. Eating the tasty household spice also might improve learning ability, according to new study results published online in the July issue of the Journal of Neuroimmune Pharmacology.

hippocampus of poor learners has less CREB (a protein involved in memory and learning) and more alpha5 subunit of GABAA receptor or GABRA5 (a protein that generates tonic inhibitory conductance in the brain) than good learners.

Power of Prior Probability med

here is the beginning of a science here because what started from reason (the first principles), then identified pathophysiology, and finally went from pathophysiology to therapeutics."

medicine is the youngest science.

Monday, 4 July 2016

"Freedom begins between the ears." ~ Edward Abby ~

"Freedom begins between the ears."

~ Edward Abby ~