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Repair of ruptured quadriceps

What the Anesthesiologist Should Know before the Operative Procedure Anatomy: Musculoskeletal: The quadriceps muscle is composed of four muscle groups – rectus femoris, vastus medialis, vastus lateralis, and vastus intermedius. The quadriceps tendon is a trilaminar structure formed by the coalescence of all four muscle tendons just proximal to the suprapatellar margin. The rectus femoris…
Hospital Medicine

Healthcare-associated infections

I. Problem/Challenge. Healthcare-associated- infections (HAIs) are associated with high morbidity and mortality, as well as high direct and indirect costs. Healthcare-associated infections include central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), surgical site infections (SSI), Clostridium difficile infections (CDI), ventilator-associated pneumonia (VAP), and healthcare-associated acquisition of multidrug-resistant organisms (MDROs) including methicillin-resistant Staphylococcus aureus.…
Hospital Medicine


I. Problem/Condition. Malnutrition in hospitalized patients is common. Though exact prevalence is difficult to calculate due to a lack of uniform criteria, most studies suggest that 30-60% of all hospitalized patients are malnourished. Furthermore, malnutrition significantly affects patient’s mortality, morbidity and length of hospital stay. Malnutrition can be defined as “an acute, subacute or chonic…
Infectious Diseases


OVERVIEW: What every practitioner needs to know Are you sure your patient has candidiasis? What should you expect to find? Key symptoms Mucosal Oral (Figure 1) Burning, altered taste sensation Vulvovaginal/balanitis Pruritus, burning Discharge, dyspareunia Cutaneous Intertriginous (Figure 2) Itch, burning, and/or pain Chronic paronychia (Figure 3) Swelling, pain of nail fold; abnormal growth of…

Neurologic Complications of Neuraxial Analgesia/Anesthesia: Postdural Puncture Headache

General Information A postdural puncture headache (PDPH) can occur following deliberate dural puncture with a spinal needle or after an unintentional dural puncture with an epidural needle. 1. Incidence The overall incidence of unintentional dural puncture with an epidural needle is considered to be 1.5%. This may be lower or higher, depending on the experience…
Hospital Medicine


Rhabdomyolysis I. What every physician needs to know. Rhabdomyolysis refers to the breakdown of skeletal muscle, with release of the skeletal muscle contents into the circulation. Substances released during rhabdomyolysis include creatine kinase (CK), myoglobin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and electrolytes such as potassium. Common presenting signs and symptoms are muscle pain, tenderness,…
Critical Care Medicine

Hypertensive disorders of pregnancy

Hypertensive disorders of pregnancy include: Pregnancy-Induced Hypertension Essential Chronic Hypertension Preeclampsia Eclampsia Other causes Renal artery stenosis Coarctation of the aorta Pheochromocytoma Cushing’s syndrome Primary aldosteronism (Conn’s syndrome) Related conditions: Pregnancy-Induced Hypertension – PIH; Gestational hypertension without proteinuria; Preeclampsia – Toxemia; Gestational hypertension with proteinuria 1. Description of the problem What every physician needs to…

Hidradenitis Suppurativa (Acne Inversa)

Are You Confident of the Diagnosis? What you should be alert for in the history Hidradenitis suppurativa (HS) is characterized by recurrent inflammatory lesions distributed bilaterally, in intertriginous areas (ie, axilla, inguinal crease, intergluteal cleft, and inframammary area). Pain and drainage of purulent material is common. The disease most commonly presents after puberty. HS often…

Other Imaging Modalities

General description of procedure, equipment, technique Cardiac computed tomography (CT) is typically subdivided into two major tests: calcium scoring (noncontrast) and CT angiography (contrast). Calcium scoring is typically used for asymptomatic persons for risk stratification and to decide upon further therapies, such as statins, or the intensity of therapy. Calcium scoring is also used for…
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