Giant Cell Arteritis

I’m looking at cases to post and found one that could be me…because I’m over 60. Here’s the lowdown: over 60 years old with sudden vision loss? over 60 years old with transient vision loss? over 60 years old with transient double vision? Think Giant Cell Arteritis and take a listen to the March EM:RAP podcast: Giant Cell Arteritis by Ilene Claudius MD and Edward Margolin MD.

Or take a quick look at the PDF and bring home the take home points…it’ll make you a giant in the know.

Who Knew? Tales of giants are found in many cultures. The word giant, first attested in 1297, was derived from the Gigantes (Greek: Γίγαντες[1]) of Greek mythology. (Wikipedia)

Rural Medicine: Diabetic Ketoacidosis

Glucometer. Courtesy Wikicommons.

Once a month I will comment on the Rural Medicine podcast from EM:RAP. It’s exciting to read CME that can be applied globally no matter where you live or what resources you have at hand. Diabetic Ketoacidosis (DKA) In The Village by Vanessa Cardy MD and Stuart Swadron MD can be found in the February 2019 EM:RAP podcasts or take a quick read of the PDF for bullet points.

The question of the month? How do you manage DKA when you don’t have access to labs? 

Urine dip strip. Courtesy Wikicommons.

And…is the urine ketone strip a good test?

Testicular Torsion – A Convoluted Case

What do Chubby Checker and testicular torsion have in common? (Wikimedia photo)

The 14-year-old male patient complained of right lower quadrant pain which varied in intensity for 1 day. He denied nausea, vomiting or fever. The abdominal exam revealed bowel sounds and mild tenderness to palpation in the right lower quadrant without rebound. His abdominal ultrasound was inconclusive; the white blood cell count mildly elevated, and the urine microscopy normal. He was admitted for observation. Twelve hours later the patient developed a fever and severe groin pain. A genital exam revealed classic findings for testicular torsion. The testicle was not salvageable. Unfortunately, the patient was born monorchism and rendered sterile by the orchidectomy. The lesson from this case: always include a genital exam in patients with lower abdominal pain.

Can you rely on the history and physical exam to rule out testicular torsion? Is the testicle salvageable after 6 hours? Wrench yourself away from your music downloads and listen to the EM:RAP August podcast called Testicular Torsion by Rob Orman MD and Larry Mellick MD. Get an update and review on this twisted entity and you won’t spiral out of control when faced with the possibility.

Who Knew? “The Twist” is an American pop song written and originally released in 1959 by Hank Ballard and the Midnighters. It was made popular by Chubby Checker, an American rock n’ roll icon, who put his stamp on the song with the twist dance style.

So what do Chubby Checker and testicular torsion have in common? As Mr. Checker said, “Come on let’s twist again…”. Testicular torsion pain can come and go.

 

Thumbs Up Nigeria

Meet Dr. Dare Ogunlusi from Ekiti State University Teaching Hospital in Nigeria. He is an attending in the Department of Accident and Emergency.

He is the newest recipient and participant in CMES. Techies Without Borders (TWB) was referred to Dr. Dare by his friend and colleague Dr. Lisa Charles from Victoria Hospital in St. Lucia. TWB mailed a thumb drive to Dr. Dare after discussing the cme options that would best work for him. He will be testing the thumb drive and providing feedback on usability and content for his specific location.

CME development and utilization face challenges worldwide because resources are limited and infrastructure for the delivery of healthcare and information is fragile. Feedback from locations around the globe helps us improve our services and products. If you have colleagues who would be interested in either CMES or CMES-Pi, please contact Dr. Debra Stoner at: deb.twb@gmail.com

Time to Charge Your Battery…

With a jolt of information on button battery ingestions by pediatrician Ilene Claudius. The November 2017 EM:RAP edition has a podcast sure to shock you. From one end of the tail to the other, your patient outcomes can range from benign ingestion and passage over a few days to death.

A variety of button batteries found in toys. (Photo from Wikimedia Commons.)

The leakage of alkaline materials will cause liquefaction necrosis rapidly. (Photo from Wikimedia Commons.)

Button battery or coin? Read the EMRAP PDF or listen to the podcast to learn how to differentiate. (Photo from http://www.radiologypics.com)

 

The National Capital Poison Center posted the NBIH Button Battery Ingestion Triage and Treatment Guideline: https://www.poison.org/battery/guideline

Battery ingestions are no laughing matter but I can’t end without one bad joke: What did the depleted battery say to the judge? “Feel free to charge me.”

 

Changing the World One CMES at a Time

Greetings CMES Users,

This blog is your educational arena. Tell us about yourselves, where you work, the challenges you face in your practice and how CMES is helping you meet your education objectives.

Share an interesting case and how you managed your patient’s care. Comment on a CMES article. Do you agree or disagree with the information?

We want to get to know each of you.  Send a picture of yourself or where you live to share with your colleagues and we will post it here on the blog.

Although I have met many of you I will start the introductions. I am Dr. Debra Stoner, a board certified emergency medicine doctor living in Pennsylvania, USA. I retired a few years ago but I listen to my cme monthly to stay up-to-date because I volunteer in several countries. I started working on CMES over one year ago and am inspired by every doctor I meet.

 

Remember…each one of you makes a difference to each life you touch.