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Anesthesiology

ORIF of ankle fracture

What the Anesthesiologist Should Know before the Operative Procedure The anesthesiologist should know the patient’s medical conditions (including additional injuries for patients who have a high-energy mechanism of injury) as well as the surgical plan. 1. What is the urgency of the surgery? What is the risk of delay in order to obtain additional preoperative…
Anesthesiology

Cesarean Delivery, Spinal, Epidural or Combined Spinal-Epidural (CSE) Anesthesia

What the Anesthesiologist Should Know before the Operative Procedure Whether a neuraxial technique is the appropriate anesthetic choice for cesarean delivery will depend on the urgency of the procedure based on fetal or maternal issues, the presence of any significant maternal comorbidities or instability, and on occasion, whether a functioning labor epidural is already in…
Pulmonary Medicine

Paraneoplastic Syndromes Associated with Lung Cancer (ectopic Cushing’s syndrome, SIADH, hypercalcemia of malignancy,Lambert-Eaton myasthenic syndrome (LEMS), paraneoplastic limbic encephalitis, paraneoplastic cerebellar degeneration, paraneoplastic opsoclonus-myoclonus, dermatomyositis)

What every physician needs to know: Lung cancer symptoms usually arise from the direct effects of tumor on the lungs or contiguous structures by compression, obstruction, or invasion of other organs. However, another important form of clinical presentation is paraneoplastic syndromes. Paraneoplastic syndromes are defined as symptoms and signs distant to the primary tumor site…
Critical Care Medicine

Low Cardiac output

1. Description of the problem What every clinician needs to know There is no consensus on the absolute definition of a “low cardiac output state.” It is a syndrome evidenced by a low cardiac output or cardiac index (cardiac index <2.4L/min/m2) with evidence of organ dysfunction—for example, a high lactate or urine output <0.5 ml/kg/hour.…
Cardiology

Managing the Patient with a Ventricular Assist Device

General description of procedure, equipment, technique Traditional management of heart failure (HF) includes medical therapy, implantable cardiac defibrillators (ICDs), and biventricular pacemakers. Despite such advances, HF continues to carry high morbidity and mortality. Five-year mortality for all patients with HF is estimated to be 50%. For those who have progressed to end-stage HF, the 1-year…
Infectious Diseases

Mediastinitis

OVERVIEW: What every practitioner needs to know Are you sure your patient has mediastinitis? What should you expect to find? Acute mediastinitis is an uncommon but potentially devastating infection involving the structures of the mediastinum. This infection can arise from perforation of the esophagus or spread from an oropharyngeal source, but most commonly occurs as…
Gastroenterology Hepatology

Chronic pancreatitis

How can I be sure that the patient has chronic pancreatitis? There are a number of clinical presentations of chronic pancreatitis. The disease usually is initially considered based on imaging findings or on symptoms. Abdominal pain is usually the earliest, most frequent, and most characteristic symptom. In many patients, the pain is often episodic early…
Dermatology

Acne vulgaris, Acne conglobata & Acne fulminans

Are You Confident of the Diagnosis? Acne is an exceptionally common disorder in adolescents, affecting up to 85% of 12-24–year olds. In fact, most patients can accurately diagnose themselves. The presence of inflammatory papules and pustules along with comedones, involving the face, chest, shoulders and back, are hallmarks of acne vulgaris. Nodules and nodulocystic lesions…
Hospital Medicine

Antiretroviral Therapy (ART) targeting HIV

Antiretroviral Therapy (ART) I. Introduction Since the first description of cases of acquired immunodeficiency syndrome (AIDS) in the early 1980s, management of patients infected with the human immunodeficiency virus (HIV) has evolved dramatically. The first medication to treat HIV (zidovudine, ZDV) came on the market in 1987. Nine years later, the first highly active antiretroviral…
Anesthesiology

Anesthesia for Breast Biopsy and Lumpectomy

What the Anesthesiologist Should Know before the Operative Procedure About one in eight (12%) of American women will develop breast cancer in their lifetime. Breast cancer is the second leading cause of cancer death in women, exceeded only by lung cancer. The chance that breast cancer will be responsible for a woman’s death is about…
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