New-Onset Seizure Evaluation in Children – Matelich

HISTORY Talk to witnesses and the patient.  Knowing events surrounding the seizure is key! Mime or description of observed physical actions during the seizure. Brief, focal symptoms prior to the dramatic event can be easily missed on a cursory history. Developmental, family and past medical histories should be covered - inherited seizure disorders, plateaus in… Continue reading New-Onset Seizure Evaluation in Children – Matelich


Interpretation of CSF – Hartman

GLUCOSE < 10 = bacterial, TB, fungal 10-40 = bacterial, viral, syphilis, mumps, LCMV normal = 2/3 of blood glucose high CSF glucose corresponds to high blood glucose low glucose is worrisome!   PROTEIN 100-500 = bacterial 50-300 = viral (<160 = enterovirus, > 100 = HSV, >900 = WNV, normal = flu) high RBCs… Continue reading Interpretation of CSF – Hartman

Evaluation and EKG Findings with Palpitations – Primary Care RAP

Copied from Primary Care RAP March podcast - an excellent overview of the workup and "red flags" on EKG. Palpitations are a common symptom seen in the outpatient setting. While most are benign, it is important to rule out more serious and potentially deadly causes. A family history of sudden cardiac death and certain EKG… Continue reading Evaluation and EKG Findings with Palpitations – Primary Care RAP

Acute Pancreatitis

Adapted from NEJM 11/17/2016 review article "Acute Pancreatitis": CAUSES: Gallstones EtOH (must be chronic use, 4-5 drinks/d x >5y) Usu acute-on-chronic pancreatitis Binge drinking does not cause acute pancreatitis Drugs (<5%) azathioprine 6-mercaptopurine valproic acid ACEIs mesalamine Idiopathic more frequent with age NON-CAUSES: Sphincter of Oddi dysfunction Pancreas divisum Binge EtOH use (in absence of… Continue reading Acute Pancreatitis

Alpha-blockers aid in passage of kidney stones (meta-analysis)

Meta-analysis: alpha blockers effective for kidney stonesClinical Question:In patients with kidney stones (ureteric calculi), is treatmentwith an alpha blocker effective in improving passage rate and decreasingpain?Bottom Line:Although a recent large study found no benefit to alpha blocker treatment (Lancet 2015;386:341-49), this meta-analysis of 55 studies found a benefit to using alpha blockers to increase the… Continue reading Alpha-blockers aid in passage of kidney stones (meta-analysis)

Physical Therapy Does Not Benefit Simple Ankle Sprains

BMJ 2016 Nov 16;355:i5650 Most ankle sprains are simple grade 1 (stable) or 2 (mild joint laxity) sprains, but often result in some persistent impairment.  Physical therapy's role in improving recovery is unclear. n= 504 (ages 16-79) presenting with grade 1 or 2 presenting within 72 hours of injury Randomized to usual care (evaluation, home… Continue reading Physical Therapy Does Not Benefit Simple Ankle Sprains