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I am the Object of My Pimp's Affection


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Guest rrkirkland

Patient has to urinate. ;)

 

Err I mean pain on pressure applied to affected leg when sitting cross legged. Indicates an ankle sprain or fx

 

Define fecalstasis.

 

I initially thought it was a joke medical term meaning "Same old S#!7"

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Nah, you just learned a nice little eponym. I've never heard of the triangle of Calot but you can be sure I knew the biliary tree. But then I didn't do a gensurg rotation, CT surg instead...so maybe I would've heard it if I had...but now I know ;)

 

To be bluntly honest, my school's surgery prep DID suck. We didn't have any, outside of the anatomy & clin med coursework. What I learned was on the fly, with a lot of help from Greenfield & Recall. :rolleyes:

 

Did I overemphasize the importance of the triangle of Calot? My surgical preceptors pimped heavily on that, insisting that the triangle must be dissected out clearly so that the cystic artery and cystic duct can be readily distinguished from each other.

 

And FOS hasn't been on the list of accepted abbreviations anywhere I've been... yet... :D

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Means the Pt is ready to be discharged or transfered to a step down. That is if they are crossing their legs and watching TV, lol.

 

very good!!!!!!!!!!!!

 

pretty true. or, at the very least, it means they are doing well. at least thats how i learned it!

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Not lethergy. Battle sign is not the answer I was looking for, but I wonder how the predictive strength of Battle sign for basilar fractures compares to this other PE finding's ability to predict skull fractures in general.

 

Maybe "most predictive" because this sign is more likely to be associated with a linear or depressed fracture, which are more common?

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Guest pac4hire

your testing me here LA i just worked a PM followed by an midshift followed by a PM at 3 different institutions so ill try....does it have anything to do with suture lines?

 

 

Hey I got one that is not a pimp but a question because im to lazy to look it up....

 

Why does increasing the urine PH help in eliminating proteins ( had a patient with a CK of 80K last night after working out ( rhabdo) and i saw a reference for 3 amps of bicarb in d5w to increase urine PH to help with excretion....

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your testing me here LA i just worked a PM followed by an midshift followed by a PM at 3 different institutions so ill try....does it have anything to do with suture lines?

 

 

Hey I got one that is not a pimp but a question because im to lazy to look it up....

 

Why does increasing the urine PH help in eliminating proteins ( had a patient with a CK of 80K last night after working out ( rhabdo) and i saw a reference for 3 amps of bicarb in d5w to increase urine PH to help with excretion....

 

i think alkalinizing the urine prevents precipitation of myoglobin in the kidney tubules and minimizes risk of ARF...

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Why does increasing the urine PH help in eliminating proteins ( had a patient with a CK of 80K last night after working out ( rhabdo) and i saw a reference for 3 amps of bicarb in d5w to increase urine PH to help with excretion....

 

Perhaps another urban legend of medicine (right up there with renal dose dopamine).....

 

I think the first study is stronger.

 

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Preventing renal failure in patients with rhabdomyolysis: do bicarbonate and mannitol make a difference?

 

BACKGROUND: The combination of bicarbonate and mannitol (BIC/MAN) is commonly used to prevent renal failure (RF) in patients with rhabdomyolysis despite the absence of sufficient evidence validating its use. The purpose of this study was to determine whether BIC/ MAN is effective in preventing RF in patients with rhabdomyolysis caused by trauma. METHODS: This study was a review of all adult trauma intensive care unit (ICU) admissions over 5 years (January 1997-September 2002). Creatine kinase (CK) levels were checked daily (abnormal,>520 U/L). RF was defined as a creatinine greater than 2.0 mg/dL. Patients received BIC/MAN on the basis of the surgeon's discretion. RESULTS: Among 2,083 trauma ICU admissions, 85% had abnormal CK levels. Overall, RF occurred in 10% of trauma ICU patients. A CK level of 5,000 U/L was the lowest abnormal level associated with RF; 74 of 382 (19%) patients with CK greater than 5,000 U/L developed RF as compared with 143 of 1,701 (8%) patients with CK less than 5,000 U/L (p < 0.0001). Among patients with CK greater than 5,000 U/L, there was no difference in the rates of RF, dialysis, or mortality between those who received BIC/MAN and those who did not. Subanalysis of groups with various levels of CK still failed to show any benefit of BIC/MAN. CONCLUSION: Abnormal CK levels are common among critically injured patients, and a CK level greater than 5,000 U/L is associated with RF. BIC/MAN does not prevent RF, dialysis, or mortality in patients with creatine kinase levels greater than 5,000 U/L. The standard of administering BIC/MAN to patients with post-traumatic rhabdomyolysis should be reevaluated.

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Prophylaxis of acute renal failure in patients with rhabdomyolysis.

 

 

Patients that develop rhabdomyolysis of different causes are at high risk of acute renal failure. Efforts to minimize this risk include volume repletion, treatment with mannitol, and urinary alkalinization as soon as possible after muscle injury. This is a retrospective analysis (from January 1, 1992, to December 31, 1995) of therapeutic response to prophylactic treatment in patients with rhabdomyolysis admitted to an intensive care unit (ICU). The diagnosis of rhabdomyolysis was based on creatinine kinase (CK) level (> 500 Ui/L) and the criteria for prophylaxis were: time elapsed between muscle injury to ICU admission < 48 h and serum creatinine < 3 mg/dL. Fifteen patients were treated with the association of saline, mannitol, and sodium bicarbonate (S + M + B group) and 9 patients received only saline (S group). Serum creatinine at admission was similar in both groups: 1.6 +/- 0.6 mg/dL in the S + M + B group and 1.5 +/- 0.6 mg/dL in the S group (p > 0.05). Maximum serum CK measured was 3351 +/- 1693 IU/L in the S + M + B group and 1747 +/- 2345 IU/L in the S group (p < 0.05). However the measurement of CK was earlier in S + M + B patients (1.7 vs 2.7 days after rhabdomyolysis). APACHE II scores were 16.9 +/- 7.4 and 13.4 +/- 4.9 in the S + M + MB and S groups, respectively (p > 0.05). Despite the treatment protocol the serum levels of creatinine had similar behavior and reached normal levels in all patients in 2 or 3 days. The saline infusion during the first 60 h on the ICU was 206 mL/h in the S group and 204 mL/h in S + M + B (p > 0.05). Mannitol dose was 56 g/day, and bicarbonate 225 mEq/day during 4.7 days. Our data show that progression to established renal failure can be totally avoided with prophylactic treatment, and that once appropriate saline expansion is provided, the association of mannitol and bicarbonate seems to be unnecessary.

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None of the above, per my sources (pedi neurosurg & confirmed by UTD, although UTD lists it as predictive up to 11 months)... although depression & crepitus is kinda a ringer...

 

I'm surprised you guys are stumped, but it sure makes me feel better because I didn't know either until the surgeon told me :p

 

ok i am guessing now:

 

retinal hemorrhages (seen in shaken baby syndrome)

hemotympanum

scalp hematoma

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  • 1 month later...

So I use to work as an ER tech at a trauma center here in town. Huge benefit is my bountiful resources of PA's I worked with for many years. Occasionally, during my "free time" :p, I'll follow one around to try and bring concepts together.

A few weeks ago the PA was seeing an elderly woman who had internally rotated her left ankle, tripped and fell. Her only complaint was ankle/foot pain. X-ray showed no fracture, but she had point tenderness in the left foot. One of the questions the PA had for me was: Why would we want to this patient to have another x-ray, of the left ankle/foot in approx 10 days?

 

T

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Ah ha...that was my answer as well. Which prompted the PA to ask why would we see a fracture in ~10 days post injury, that we couldnt' see that day with the present X-ray, which was negative for fracture. I too thought swelling might obscure reading the xray...but according to this PA that was not the case :)

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Guest pac4hire

delaye xray images are obtained #1 for medicolegal CYA. #2 calus formation (bone remodeling) can identify an occult fracture that was previously missed.

 

 

I always splint everyone with an ankle injury. you cant get sued for treating a sprain like a fracture but the opposite is a lawsuit waiting to happen.

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Ding ding...I suppose this is more of a student question, bringing us back to good old med physiology. He essentially stated the same, the osteoblast activity...new bone formation...visible fx line approx 7-10 days out.

 

I had not had Ortho yet, actually just started that block today, and had overlooked the physiology aspect.

 

So how about some questions from the more seasoned PA's to help keep us students on our toes :D

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  • 4 months later...

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