DOCSLIB.ORG

First Shift of Residency

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
First Shift of Residency ResidentOfficial Publication of the Emergency Medicine Residents’ Association June/July 2018 VOL 45 / ISSUE 3 First Shift of Residency Examining the DAWN and DEFUSE 3 Trials Simplified Approach to TEG and ROTEM Modern Trends in Blast Injuries ENVISION PHYSICIAN SERVICES OFFERS ... programs that align physicians to become leaders MANSOOR KHAN, MD, MHA, FAAEM EMERGENCY MEDICINE Why EM Residents choose Envision Physician Services ■ Professional Development and Career Advancement ■ Employment Flexibility: Full-Time, Part-Time, moonlighting and travel team. Employed and Independent Contractor options ■ Practice Variety: Coast-to-coast opportunities at well-recognized hospitals and health systems ■ Unparalleled practice support ■ Earn While You Learn Program: Provides senior residents with $2,500/month while you complete your residency For more information, contact: 877.226.6059 [email protected] Letter from the Editor ENOUGH IS ENOUGH Tommy Eales, DO Editor-in-Chief, EM Resident Indiana University @tommyeales Editor’s Note: Gun violence continues to have a dramatic impact on our society, and the EMRA Representative Council is discussing the topic to form EMRA’s official stance. This letter reflects my opinions. “Time of death — 2:31 am.” rate of gun-related deaths among ugliness and even accept it as unchangeable, 1 stared at the lifeless child in front of industrialized countries. Every year, the insurmountable. Yet, there are some things me — the focal point of a quiet, well- number of Americans who will die from that should never be normalized. disciplined trauma resuscitation. There gunshot wounds rivals the number of those The next time you hold a parent’s hand I who die from sepsis.2 Perhaps a striking while confirming the worst possible news, were blank faces around the room. And for statistic to some, this should come as no here’s my advice. a moment, absolute silence. surprise to those of us working in crowded Apologize. Then, from beyond the curtain, a slow, EDs across the country. Apologize that our society normalizes piercing cry. Despite the media attention and public gun violence to the extent that no action I carefully removed my blood-stained outcry associated with the violent deaths of will be taken to address the systemic flaws gloves and gown, pausing to ensure that young children, the sobering reality is that that contributed to her child’s death. my scrubs bore no evidence of the grisly the majority of gunshot-wound fatalities Apologize that our professional scene that just enfolded. I washed my in America occur in adults and are self- organizations have failed to reverse the hands and took a deep breath. As I stepped inflicted.2 These stories will never make caustic legislation preventing us from out of the resuscitation bay, I came face- the evening news. If only we could do a collecting and analyzing the data we need to-face with the patient’s mother. Words better job of identifying those at risk and to create evidence-based guidelines to fight cannot capture her desperate, glassy stare intervening earlier, perhaps these deaths gun violence across the country. as her eyes met mine. might one day be preventable. Apologize that emergency medical and Before I could even speak, she knew. Embarrassingly, we have dangerously surgical staff have become immune to the In the moments that followed, we limited data pertaining to gun violence. emotions associated with gun violence and shared a simple discussion that would This is critical information we need to save death. change her life forever. I explained that lives. Talking to my patient’s mother her child had suffered a gunshot wound Compared with other leading causes that night, I told her that we had done to the chest that caused her heart to stop of death, gun violence was associated everything in our power to save her child. beating just prior to reaching the hospital. with less funding and fewer publications But what about my next patient? Have Without divulging too many details than predicted based on mortality rate, I done everything in my power to prevent about the exhaustive measures that were with approximately 1.6% of the funding others from becoming victims of gun attempted to revive her upon arrival to the and 4.5% of the volume of publications violence? ED, I assured the grief-stricken mother predicted by a regression analysis As the frontline of the healthcare that every effort was made to save her incorporating the leading causes of death system, gun violence is our problem. It baby. “I’m sorry,” I concluded. “She died.” reported by the CDC between 2004- is our responsibility to stand up and take Not 20 minutes later, I was back at 2014.3 While the reasoning for this is ownership of this. Short of that, we are my workstation and catching up on charts multifactorial, the major driving force is the doing an injustice to our patients. Every during a rare lull in the steady onslaught of gun lobby — a collection of various groups time we quietly go back to work after new arrivals. working tirelessly to restrict federal funding another young person’s violent death, we Gun violence has become so routine in for researchers investigating gun violence. make it easier for this to remain the status the ED that not even the gruesome death Life in the ED is unpredictable. We quo. As physicians, it is our duty to speak up of a young child can interrupt the daily routinely come face-to-face with the for those who cannot speak for themselves. grind. struggles of our communities. Over time, I speak for my deceased patients when I In fact, the U.S. now has the highest there is a tendency to normalize the say that enough is enough. ¬ References available online. June/July 2018 | EM Resident 1 TABLE OF CONTENTS EDITORIAL STAFF Categories EDITOR-IN-CHIEF Tommy Eales, DO COVER STORY Indiana University 14 Welcome to DEPUTY EDITOR Brian Fromm, MD Emergency Thomas Jefferson University Medicine Blake Baker, MD, MPH, completed his first EDITORIAL TEAM shift as a physician on the night of a mass Jeremy Lacocque, DO shooting in Dallas. How can this year’s interns Midwestern University/CCOM prepare for their own first shifts — and first month of residency? Megan Cobb, MD On the cover: Blake Baker is beginning his final year of residency at UT Southwestern, University of Maryland rotating at Parkland Health & Hospital System. Jayram Pai, MD Mount Sinai PRESIDENT’S MESSAGE COVER STORY SUPPLEMENT 5 #EMRAatCORD18 16 How Did You Survive Leah McDonald, MD the First Month NYU/Bellevue Medical Center of Residency? Karen Bowers, MD, MS, MEd Emory University Event WELLNESS Recap 18 Whitney Johnson, MD Emotional Intelligence UCSF-Fresno in the Emergency Department Danny VanValkinburgh, MD ACGME RC-EM UPDATE University of Tennessee College of Medicine 6 ACGME Review Committee for ECG Editor Emergency Medicine Jeremy Berberian, MD Updates Christiana Care Health System WELLNESS 20 Applying Cognitive Load LEADERSHIP REPORT MSC Editor Theory to Emergency Morgan Bobb 8 Introducing EMRA’s Medicine Handoffs University of Iowa Carver New Administration & College of Medicine Operations Committee CRITICAL CARE EM Resident (ISSN 2377-438X) is the bi- 10 Examining DAWN monthly magazine of the Emergency Medicine and DEFUSE 3 Residents’ Association (EMRA). The opinions herein are those of the authors and not of Endovascular Therapy EMRA or any institutions, organizations, or Option for Late-Presenting federal agencies. EMRA encourages readers Ischemic Stroke Patients TRAUMA to inform themselves fully about all issues 22 Modern presented. EM Resident reserves the right AIRWAY Trends to edit all material and does not guarantee publication. 13 Delayed Sequence in Blast © Copyright 2018 Intubation Injuries Emergency Medicine Residents’ Association Basics for Residents 2 EMRA | emra.org • emresident.org UPCOMING EVENTS June 15: 20 in 6 Resident Lecture Entries PREHOSPITAL CARE INFECTIOUS DISEASE Due 24 34 June 19-22: Resuscitation 2018 — discount Cervical Collar Tamiflu for EMRA members! Baltimore, MD To Use or July 15: Fall Award Application Due Not to Use? Aug. 5: EM Resident Articles Due Aug. 18: EMRA Board Nominations Due TRAUMA Aug. 18: Fall Resolutions Due 37 A Simplified Treatment- Sept. 15: 2019 Main Registry Match opens @ Noon EDST Friend or Foe? Based Approach to TEG and ROTEM Sept. 28-Oct. 4: EMRA Events at ACEP18, San Diego PULMONARY DISORDERS Sept. 30: EMRA Residency Program Fair PREHOSPITAL 25 Super Bowl-induced 40 @ ACEP18 Spontaneous Rescue Oct. 1: EMRA Job & Fellowship Fair @ ACEP18 Pneumomediastinum Task Force Oct. 13-16: ABEM Fall Oral Certification Exam Super-Fan Oct. 5: EM Resident Articles Due Life Nov. 30: NRMP standard registration deadline RESEARCH Jan. 30: NRMP rank order list entry opens @ Noon ET 42 How to Get Published Feb. 20: NRMP rank order lists due PROCEDURE/CRITICAL CARE 26 The Use of the Angiocatheter in Central Line Insertion Paper Hack 101 First Thursday of every month MEDICAL STUDENTS EMRA-Cast: 44 Required Clerkships Listen Setting the at your Foundation convenience CRITICAL CARE for a Career 28 in Emergency Hepatic Medicine Syndromes ADVERTISE WITH US EM POWER PRINT AND ONLINE MARKETING 46 Jo Linder, MD, OPPORTUNITIES AVAILABLE ORTHOPEDICS FACEP Contact Cynthia Kucera | 201-767-4170 30 Posterior Sternoclavicular [email protected] Joint Dislocation Download EM Resident Media Kit ECG CHALLENGE 47 emra.org/advertise Be sure to check EMResident.org Recanting Impressions for exclusive online content! RESPIRATORY Want to improve your CV? 32 Considerations Performing Write for EM Resident! BOARD REVIEW ED Thoracentesis Submit online at emresident.org. “Trapped Tap” 50 Questions from PEER IX June/July 2018 | EM Resident 3 EmBassador Travel Team Seeking the Best and Brightest EM Physicians Enjoy the flexibility to live where you want and practice where you are needed.
Load more

Recommended publications
  • Danielle Ofri
    ingular S Intimacies BECOMING A DOCTOR AT BELLEVUE Danielle Ofri BEACON PRESS BOSTON Beacon Press Boston, Massachusetts www.beacon.org Beacon Press bo oks are published under the auspices of the Unitarian Universalist Association of Congregations. © 2003 by Danielle Ofri All rights reserved Printed in the United States of America 12 11 10 9 8 7 6 5 4 3 2 1 Excerpt from “Desert Places” from The Poetry of Robert Frost edited by Edward Connery Lathem. Copyright 1936 by Robert Frost, © 1964 by Lesley Frost Ballantine, © 1969 by Henry Holt and Company. Reprinted by permission of Henry Holt and Company, LLC. Excerpt from “Gaudeamus Igitur” by John Stone, reprinted from Renaming the Streets, Louisiana State Univ. Press, 1985. Used with the permission of the author. This book is printed on acid-free paper that meets the uncoated paper ANSI/NISO specifications for permanence as revised in 1992. The names and many distinguishing characteristics of patients mentioned in this work have been changed to protect their identities. Text design by Anne Chalmers Composition by Wilsted & Taylor Publishing Services Library of Congress Cataloging-in-Publication Data Ofri, Danielle. Singular intimacies : becoming a doctor at Bellevue / Danielle Ofri. p.;cm. isbn 978-0-8070-7251-6 (paperback : alk. paper) 1. Ofri, Danielle. 2.Women physicians—United States—Biography. 3.Physicians—United States—Biography. 4.Women physicians—Training of. 5.Medical history taking—Anecdotes. i.Title. [dnlm: 1.Bellevue Hospital. 2. Clinical Clerkship—Personal Narratives. 3.Medical History Taking—Personal Narratives. 4.Preceptorship—Personal Narratives. wb 290 033t 2002] r692.035 2002 610′.92—dc21 [B] 2002012461 Not for distribution.
    [Show full text]
  • Provoked Exercise Desaturation in Patent Foramen Ovale and Impact of Percutaneous Closure
    JACC: CARDIOVASCULAR INTERVENTIONS VOL. 5, NO. 4, 2012 © 2012 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION ISSN 1936-8798/$36.00 PUBLISHED BY ELSEVIER INC. DOI: 10.1016/j.jcin.2012.01.011 Provoked Exercise Desaturation in Patent Foramen Ovale and Impact of Percutaneous Closure Ganesh P. Devendra, MD,* Ajinkya A. Rane, BS,† Richard A. Krasuski, MD‡ San Francisco, California; and Cleveland, Ohio Objectives This study was designed to assess the prevalence of provoked exercise desaturation (PED) in patients with patent foramen ovale (PFO) referred for cardiovascular evaluation and to eval- uate the impact of PFO closure. Background Platypnea orthodeoxia syndrome is a rare, mechanistically obscure consequence of PFO that results in oxygen desaturation during postural changes. In our clinical experience, how- ever, it is far less common than desaturation during exercise. Methods This was a single-center prospective study of 50 patients with newly diagnosed PFO. Each patient underwent standardized assessment for arterial oxygen saturation with pulse oximetry dur- ing postural changes and stair climbing exercise. Provoked exercise desaturation was defined as a desaturation of at least 8% from baseline to Ͻ90%. All patients who underwent closure were re- evaluated 3 months after the procedure. Those with baseline PED were similarly reassessed for desatura- tion at follow-up. Results Mean age of the cohort was 46 Ϯ 17 years, 74% were female, 30% had migraines, and 48% had experienced a cerebrovascular event. Seventeen patients (34%) demonstrated PED. Pro- voked exercise desaturation patients seemed demographically similar to non-PED patients. Ten PED patients underwent PFO closure (2 surgical, and 8 percutaneous).
    [Show full text]
  • Platypnea-Orthodeoxia Syndrome: a Rare and Treatable Cause of Positional Dyspnea
    Open Access Case Report DOI: 10.7759/cureus.9052 Platypnea-Orthodeoxia Syndrome: A Rare and Treatable Cause of Positional Dyspnea Karan Puri 1 , Ghulam Aftab 2 , Arjun Madhavan 3 , Keval V. Patel 4, 5 , Megha Puri 6 1. Internal Medicine, Saint Peter's University Hospital, New Brunswick, USA 2. Pulmonary Medicine, Saint Peter's University Hospital, New Brunswick, USA 3. Critical Care, Saint Peter’s University Hospital, New Brunswick, USA 4. Cardiology, Saint Peter’s University Hospital, New Brunswick, USA 5. Cardiology, Rutgers-Robert Wood Johnson University Hospital, New Brunswick, USA 6. Pathology, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, IND Corresponding author: Karan Puri, [email protected] Abstract Platypnea-orthodeoxia means low oxygen saturation and dyspnea in the upright posture which improves on lying down. The causes can be classified into the intrapulmonary shunt, intracardiac shunt, and ventilation- perfusion mismatch. A 62-year-old male presented with shortness of breath, which had worsened over a period of one year. Various investigations were done to rule bacterial, viral infection, pulmonary embolism, and other respiratory and cardiac causes. The initial echocardiogram showed an ejection fraction of 55%. The patient was observed to be having dyspnea only in the upright position. In the recumbent position, the dyspnea disappeared with a marked improvement in oxygen saturation. A repeat echocardiogram with a bubble study was done which showed an atrial septal defect. Surgical closure of the defect was performed which improved the patient’s oxygen saturation to baseline normal. This case demonstrates that a vigilant approach is required in cases of dyspnea, keeping in mind the not-so-common phenomenon like platypnea- orthodeoxia syndrome Categories: Cardiology, Internal Medicine, Pulmonology Keywords: orthodeoxia, platypnea, intracardiac shunts, intrapulmonary shunts, hyperoxia test Introduction Orthodeoxia means low oxygen saturation in the upright posture and improvement when lying down.
    [Show full text]
  • Imaging: Results and Hospital Course: • Patient Initially Presented to RMH on 8/20/2019
    Introduction / HPI: Imaging: Results and Hospital Course: • Patient initially presented to RMH on 8/20/2019. He was treated for RLE 27 yo male with past medical history of IVDA presented to cellulitis with a washout; as well as, IV Cefazolin for MSSA + Blood Roxborough Memorial Hospital (RMH) with right leg swelling for 5 cultures. Blood cultures remained positive x4; spurring a TTE, which was days and shortness of breath. The patient stated that 5 days prior he negative for vegetations. CXR preformed demonstrated concern for septic was using heroin and injecting the needle into his right medial foot. He embolic, spurring a Chest CT with reported finding of said that the following day he noticed a blister forming and sliced it hydropneumothorax. Patient was transferred to TJUH on 8/28 for the with a knife that he cleaned with soap and water. The next day he possibility of needing cardiothoracic surgery capabilities. noticed swelling of his foot with progressing redness and pain traveling up his leg to his knee. He described the pain as a 5 out of 10 when at • He was admitted to the TJUH SICU. Subsequently the patient had rest and a 7 out of 10 when walking on it. He stated that he has been multiple episodes of bloody BM’s and his Hgb dropped to 6.9. He taking 1 tablet of Motrin per day for last 3 days with minimal received 2 units pRBC’s with appropriate hemodynamic response. GI was relief. He endorsed shortness of breath when at rest and exertion, chest consulted, whom preformed an EGD and colonoscopy on 9/9.
    [Show full text]
  • PEDIATRIC SURGERY WELCOME to PEDIATRIC SURGERY This Is a Busy Surgical Service with Lots to See and Do
    Medical Students Guide to PEDIATRIC SURGERY WELCOME TO PEDIATRIC SURGERY This is a busy surgical service with lots to see and do. Our goal is to integrate you into the service so that you can get the best experience possible during your time here. This guide details the structure of our service along with some pointers to help get you up and running. DAILY SCHEDULE 6 a.m. Morning rounds * 6th fl, East, NICU front desk 7 a.m. Radiology rounds 2nd fl, East, Radiology Body reading room 7:30 a.m. OR start (starts at 8:30 a.m. on Thurs) 2nd fl, Main 8 a.m. - 4 p.m. Clinic 4th fl Main, Suite 4400 5 p.m. Afternoon rounds 5th fl, East (outside room 501) *Sat & Sun rounds start at 7 or 7:30 a.m., confirm time with team ROTATION SCHEDULE Your rotation will start on August 31 and will end on September 18, 2020. See attached schedule. TEACHING SESSIONS: General surgery clinic days are Mondays, 1 Tuesdays, Thursdays and Fridays in Suite 4400 7:00 – 9:00 A.M. Telehealth clinics are generally scheduled at Thursday 2 the end of clinic Morning Pediatric Surgery Conference Guzzetta Library General surgery elective OR days by faculty 3 members are each day. 3:00 – 5:30 P.M. generally between Tuesdays and Fridays 4 The add-on room runs each day. Medical student lectures Guzzetta Library Your schedule will include time spent in the 5 surgery clinic, in the OR, with the consult resident, and with the surgeon of the day.
    [Show full text]
  • How Undergraduate Nursing and Medical Students Make Sense of Cultural Representations of Their Professions
    Kansas State University Libraries New Prairie Press 2011 Conference Proceedings (Toronto, ON, Adult Education Research Conference Canada) Watch, Learn and Become: How Undergraduate Nursing and Medical Students Make Sense of Cultural Representations of their Professions Kaela Jubas University of Calgary Patricia Knutson University of Calgary Kerry McArthur University of Calgary Follow this and additional works at: https://newprairiepress.org/aerc Part of the Adult and Continuing Education Administration Commons This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License Recommended Citation Jubas, Kaela; Knutson, Patricia; and McArthur, Kerry (2011). "Watch, Learn and Become: How Undergraduate Nursing and Medical Students Make Sense of Cultural Representations of their Professions," Adult Education Research Conference. https://newprairiepress.org/aerc/2011/papers/50 This is brought to you for free and open access by the Conferences at New Prairie Press. It has been accepted for inclusion in Adult Education Research Conference by an authorized administrator of New Prairie Press. For more information, please contact [email protected]. Watch, Learn and Become: How Undergraduate Nursing and Medical Students Make Sense of Cultural Representations of their Professions Kaela Jubas, Patricia Knutson & Kerry McArthur University of Calgary Keywords: Culture as pedagogy; Work-related learning; Identity; Ethics Abstract: This paper discusses preliminary findings of a study exploring the pedagogical functions of pop culture. We use Grey’s Anatomy and Scrubs to explore cultural portrayals of and messages about work-related learning with undergraduate medical and nursing students. Thematically, our analysis emphasizes learning about identity, ethics and pedagogy. Introduction This paper discusses preliminary findings of a research project, funded by the University of Calgary Starter Grant and SSHRC Standard Research Grant programs, exploring the pedagogical functions of popular culture.
    [Show full text]
  • Malignant Pleural Mesothelioma Presenting with a Spontaneous
    Rev Port Pneumol. 2012;18(2):93—95 www.revportpneumol.org CASE REPORT Malignant pleural mesothelioma presenting with a spontaneous hydropneumothorax: A report of 2 cases a a a,b,∗ H.Z. Saleh , E. Fontaine , H. Elsayed a Cardiothoracic Department, Liverpool Heart and Chest Hospital, Liverpool, UK b Thoracic Surgery Department, Ain Shams University, Cairo, Egypt Received 10 February 2011; accepted 26 April 2011 KEYWORDS Abstract Malignant pleural mesothelioma (MPM) originates in the mesothelial cells that line Mesothelioma and the pleural cavities. Most patients initially experience the insidious onset of chest pain or hydropneumothorax; shortness of breath and have a history of asbestos exposure. It rarely presents as spontaneous Challenging diagnosis pneumothorax. We report here two cases where malignant pleural mesothelioma presented with a spontaneous hydropneumothorax and was only discovered following surgery. We emphasise the need for a chest CT-scan preoperatively in older patients presenting with a secondary pneumo/hydropneumothorax. © 2011 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L. All rights reserved. PALAVRAS-CHAVE O Mesotelioma Pleural Maligno apresentando-seapresenta-se com um hidropneumotórax espontâneo: descrição de 2 casos Mesotelioma e Um relatório sobre 2 casos hidropneumotórax; Diagnóstico Resumo O Mesotelioma Pleural Maligno (MPM) tem origem nas células mesoteliais que desafiante revestem as cavidades pleurais.da pleura. A maioria dos pacientes sente, inicialmente, uma dor torácica insidiosa ou dispneia e tem umumahistorial história de exposic¸ão a abestos. Raramente apresenta-se como um pneumotórax espontâneo.DescrevemosRegistamos dois casos em que o mesotelioma pleural maligno se apresentou com um hidropneumotórax espontâneo e só foi descoberto após a cirurgia.
    [Show full text]
  • Cerebral Air Embolism After Indwelling Pleural Catheter Insertion in A
    Case report BMJ Case Rep: first published as 10.1136/bcr-2021-244006 on 29 July 2021. Downloaded from Cerebral air embolism after indwelling pleural catheter insertion in a chronic hydropneumothorax secondary to epithelioid mesothelioma Dissanayake Mudiyanselage Chanaka Jayawardena , Rakesh K Panchal, Sanjay Agrawal, Indrajeet Das Respiratory Medicine, Glenfield SUMMARY The patient was Eastern Cooperative Oncology Hospital, Leicester, UK A 75- year- old man with a history of epithelioid Group performance status 0 and was under the mesothelioma and a right-sided indwelling pleural ambulatory pleural service but managed his pleural Correspondence to catheter (IPC) presented with a history of a purulent fluid collections independently in the community. The Dr Dissanayake Mudiyanselage Chanaka Jayawardena; drainage via the IPC. The pleural fluid cultured Klebsiella IPC had been inserted 3½ years ago for a right- Chanj858@ gmail. com oxytoca and Enterococcus faecalis. He was treated with sided loculated hydropneumothorax that had a course of oral fluoroquinolone followed by uneventful developed after a radical extended pleurectomy, Accepted 13 July 2021 IPC replacement. One and half hours postprocedure, decortication and diaphragmatic patch surgery for the patient had a witnessed drop in conscious level mesothelioma. The rationale for the IPC was recur- accompanied by seizure like activity. Acute stroke was rent effusions and associated infections requiring suspected and a CT head was performed. CT head repeat chest drains in the area of the postoperative revealed multiple serpiginous pockets of air along the hydropneumothorax. cerebral fissure, with features that were highly suggestive The patient was asymptomatic and apyrexial. of cerebral air embolism and multiple wedge-shaped The pleural fluid cultured Klebsiella oxytoca and areas of infarction involving the cerebral hemispheres.
    [Show full text]
  • Platypnoea–Orthodeoxia Syndrome in COVID-19 Adarsh Aayilliath K, Komal Singh, Animesh Ray ‍ ‍ , Naveet Wig
    Case report BMJ Case Rep: first published as 10.1136/bcr-2021-243016 on 5 May 2021. Downloaded from Platypnoea–orthodeoxia syndrome in COVID-19 Adarsh Aayilliath K, Komal Singh, Animesh Ray , Naveet Wig Department of Medicine, AIIMS, SUMMARY mainly in a peripheral and subpleural location. New Delhi, India Platypnoea–orthodeoxia syndrome (POS) is a rare Patients with COVID-19 can have postural varia- entity characterised by respiratory distress and/or tion of respiratory distress, and this fact is used in Correspondence to hypoxia developing in the sitting/upright posture, the strategy of awake proning in the management Dr Animesh Ray; 2 doctoranimeshray@ gmail. com which is relieved in the supine posture. It is caused by of COVID-19 ARDS. However, platypnoea–orth- cardiac, pulmonary and non- cardiopulmonary diseases. odeoxia syndrome (POS) is a rare manifestation in Accepted 6 April 2021 COVID-19 can have varying respiratory manifestations COVID-19 and has been sparsely reported. Here including acute respiratory distress syndrome (ARDS) we report an interesting case of COVID-19 who and sequelae- like pulmonary fibrosis. POS has been showed characteristic features of POS during the rarely reported in patients with COVID-19. Here we recovery phase. report a case of POS in a patient recovering from severe COVID-19 ARDS. As he was gradually mobilised after his improvement, he had worsening dyspnoea in the CASE PRESENTATION sitting position with significant relief on assuming a A- 46- year old man from Delhi presented with fever supine posture. He was diagnosed with POS after ruling of 7 days and breathlessness of 3 days’ duration.
    [Show full text]
  • Supermicar Data Entry Instructions, 2007 363 Pp. Pdf Icon[PDF
    SUPERMICAR TABLE OF CONTENTS Chapter I - Introduction to SuperMICAR ........................................... 1 A. History and Background .............................................. 1 Chapter II – The Death Certificate ..................................................... 3 Exercise 1 – Reading Death Certificate ........................... 7 Chapter III Basic Data Entry Instructions ....................................... 12 A. Creating a SuperMICAR File ....................................... 14 B. Entering and Saving Certificate Data........................... 18 C. Adding Certificates using SuperMICAR....................... 19 1. Opening a file........................................................ 19 2. Certificate.............................................................. 19 3. Sex........................................................................ 20 4. Date of Death........................................................ 20 5. Age: Number of Units ........................................... 20 6. Age: Unit............................................................... 20 7. Part I, Cause of Death .......................................... 21 8. Duration ................................................................ 22 9. Part II, Cause of Death ......................................... 22 10. Was Autopsy Performed....................................... 23 11. Were Autopsy Findings Available ......................... 23 12. Tobacco................................................................ 24 13. Pregnancy............................................................
    [Show full text]
  • Pneumothorax Following Thoracentesis a Systematic Review and Meta-Analysis
    REVIEW ARTICLE Pneumothorax Following Thoracentesis A Systematic Review and Meta-analysis Craig E. Gordon, MD, MS; David Feller-Kopman, MD; Ethan M. Balk, MD, MPH; Gerald W. Smetana, MD Background: Little is known about the factors related to but this was nonsignificant within studies directly com- the development of pneumothorax following thoracente- paring this factor (OR, 0.7; 95% CI, 0.2-2.3). Pneumotho- sis. We aimed to determine the mean pneumothorax rate rax was more likely following therapeutic thoracentesis (OR, following thoracentesis and to identify risk factors for pneu- 2.6; 95% CI, 1.8-3.8), in conjunction with periprocedural mothorax through a systematic review and meta-analysis. symptoms (OR, 26.6; 95% CI, 2.7-262.5), and in associa- tion with, although nonsignificantly, mechanical ventila- Methods: We reviewed MEDLINE-indexed studies from tion (OR, 4.0; 95% CI, 0.95-16.8). Two or more needle January 1, 1966, through April 1, 2009, and included stud- passes conferred a nonsignificant increased risk of pneu- ies of any design with at least 10 patients that reported mothorax (OR, 2.5; 95% CI, 0.3-20.1). the pneumothorax rate following thoracentesis. Two in- vestigators independently extracted data on the pneu- Conclusions: Iatrogenic pneumothorax is a common mothorax rate, risk factors for pneumothorax, and study complication of thoracentesis and frequently requires methodological quality. chest tube insertion. Real-time ultrasonography use is a modifiable factor that reduces the pneumothorax rate. Results: Twenty-four studies reported pneumothorax rates Performance of thoracentesis for therapeutic purposes and following 6605 thoracenteses. The overall pneumothorax in patients undergoing mechanical ventilation confers a rate was 6.0% (95% confidence interval [CI], 4.6%-7.8%), higher likelihood of pneumothorax.
    [Show full text]
  • Letters to a Third Year Student from the Class of 2021 School of Medicine Letters to a Third-Year Student
    LETTERS TO A THIRD YEAR STUDENT FROM THE CLASS OF 2021 SCHOOL OF MEDICINE LETTERS TO A THIRD-YEAR STUDENT FROM THE CLASS OF 2021 SCHOOL OF MEDICINE Founding Editor: THERESE JONES, PHD DIRECTOR, ARTS AND HUMANITIES IN HEALTHCARE PROGRAM Managing Editor: ANJALI DHURANDHAR, MD ASSOCIATE DIRECTOR, ARTS AND HUMANITIES IN HEALTHCARE PROGRAM COVER ART: ANJALI DHURANDHAR, MD COVER ART PHOTOGRAPHER: MAX OSBORNE 720-338-3284 FRONT COVER LAYOUT AND DESIGN: HALI JENKINS BACK COVER DESIGN: ANJALI DHURANDHAR, MD GRAPHIC DESIGN AND LAYOUT: ANJALI DHURANDHAR, MD APRIL 20, 2021 LETTERS COLLECTED FROM HIDDEN CURRICULUM, FOUNDATIONS OF DOCTORING, THE STUDENT ADVISORS FOR THE ADVISORY COLLEGES, THE GOLD HUMANISM HONOR SOCIETY and THE ARTS AND HUMANITIES IN HEALTHCARE PROGRAM This publication was made possible by the generous support of the Undergraduate Medical Education Office in the School of Medicine, Arts and Humanities in Healthcare Program Center for Bioethics and Humanities University of Colorado Anschutz Medical Campus TABLE OF CONTENTS FOREWORD AMIRA DEL PINO-JONES MD ........................................................................................... 1 INTRODUCTION THERESE JONES, PHD ....................................................................................................... 2 FROM THE GOLD HUMANIISM HONOR SOCIETY BRENNA CAMERON, GAVRIEL RODA, YAA ASARE, AMELIA DAVIS ............................... 3 LETTERS TO A THIRD-YEAR STUDENT NICHOLAS BIANCHINA ..................................................................................................
    [Show full text]