78 yo f presents with generalized weakness. Patient denies any complaints per se and was brought in by family member after patient could not answer her door due to her weakness. Vital signs were stable. Physical exam was unremarkable and she had not other ROS complaints. Initial venous blood gas revealed pH of 7.21, pco2 […]

23 year old male with HIV presents with 1 week of fever, cough with yellow sputum, malaise presents with worsening of symptoms. Patient has vital signs of T103, P110, BP135/89, sat 90% on RA. Physical exam reveals coarse rhonchi bilaterally. His initial pa02 is 78 mm Hg. Below is the chest x-ray.     What […]

It has been a long, eventful week in the wake of the tragedies in Boston and to honor those who were affected by the attacks, I would like those who are able, to have a moment of silence at 2:50 PM.  To those further interested, below is the link to ‘The One Fund Boston’ to […]

Good morning! Please see above for a response to last week’s tragedy.   44 yo female presenting with nausea, vomiting and abdominal pain. Patient is a chronic alcoholic with no other drug use admitted. Patient is tachycardic to 116 and hypotensive 90/68. She is alert and oriented x 3 but actively vomiting clear non-bilious and […]

Vasopressors and Inotropes in the Critically Ill Patient  RECEPTORS:  Alpha-1 adrenergic receptors are located in vascular walls, induces significant vasoconstriction  Beta-1 adrenergic receptors are most common in the heart and mediate ionotropy and chronotropy    Beta-2 adrenergic receptors in blood vessels induces vasodilatation  Dopamine receptors are present in the renal, splanchnic, coronary, and cerebral vascular […]

Quick and Dirty- ESCHARTOMY   Full-thickness skin burns result in the formation of a tough, inelastic mass of burnt tissue/eschar. By virtue of this inelasticity, there may be accumulation of fluid within the confined anatomic spaces underlying the eschar potentially resulting in a burn induced compartment syndrome. Briefly, compartment syndrome is defined as a compartmental […]

  STATUS EPILEPTICUS Persistent seizure >5minutes or recurrent seizures without return to consciousness in 5 minutes Initial Treatment Lorazepam (preferred over diazepam because longer t1/2 of distribution in CNS): 2-4 mg IV every 10-15 minutes (maximum dose 12mg) Fosphenytoin: 20 PE/kg IV at a rate of 150 PE/min or Phenytoin: 20 mg/kg at a rate of 50 […]