CONSULT, CONSULT, CONSULT! When to consult? Patient is well below their baseline functional status with potential for this to improve in a reasonable amount of time. Medical needs beyond typical capability of subacute care (SNF). Rehab diagnosis: 60% have to have a "rehab diagnosis" stroke, spinal cord injury, congenital deformity, amputation, major multiple trauma, femur… Continue reading Inpatient Rehab Pearls and Principles – Slater
DOES WORK: Keeping moving Physical therapy or manipulation therapies Acupuncture, tai chi (clinician should emphasize possible benefits - likely enhances the placebo effect!) NSAIDs - lowest effective dose for shortest period - 1st line pharmacotherapy Can try APAP in those with NSAID contraindications, but unlikely to help Duloxetine (other SNRIs may work, but evidence lacking)… Continue reading Chronic Low Back Pain: What does and does not work (according to current evidence)
This site is a calculator from the American Academy of Orthopedic Surgeons to help us decide which patients undergoing procedures are recommended to receive prophylactic antibiotics: Ortho Proph Abx Calc
(BMJ)—A committee of experts w/ experience in gout agreed upon potential targets and outcomes, which was the basis for the systematic literature search. The expert group developed 9 treat-to-target recommendations: 1. Serum urate must be measured regularly and urate-lowering tx should be adjusted to attain the therapeutic target. 2. Serum urate level <6 mg/dL should… Continue reading Gout – Treatment Guidelines
Notes on what primary docs need to know about inflammatory back pain before referring to rheumatology. From lecture by Dr Sandra Horvath-Dori, 4/5/17.
Lecture notes from presentation by Dr Scott Czarnecki, 04 January 2017: WHAT IS URGENT? Acute vision loss (<24h) Painful vision loss (<24h) Globe penetration (now) Flashes and floaters (<24h) Semi-urgent: HSV conjunctivitis, zoster ophthalmicus (24-48h) Ptosis and blown pupil (now) Random ophtho pearls: For bacterial conjunctivitis, use Ocuflox or Polytrim. Don't use tobra or gentamicin… Continue reading Eye Manifestations of Systemic Disease – Czarnecki
Dr Rebecca Morrow's SPEP/UPEP matching game! Try your hand at it - which pattern on the right matches the protein electrophoresis pattern on the left? A monoclonal pattern is suggestive of multiple myeloma or MGUS. There will be one or two "spikes" of protein present. A normal pattern is, as you would think, a normal… Continue reading SPEP and UPEP pattern matching game!
The adult-onset Still disease triad: fever, arthralgias and an evanescent rash. adult-still-disease
From Life in the Fast Lane: Drug rash with eosinophilia and systemic symptoms (DRESS syndrome) It affects approximately 1 per 1500 new users of phenytoin and carbamazepine [Reference] The mortality rate associated with DRESS syndrome is approximately 10%, the majority due to fulminant liver failure [Reference]
Most common diagnoses in primary care: osteoarthritis, gout and trauma. Do not miss disorder: septic arthritis. Missed diagnosis can lead to sepsis, bacteremia, joint destruction or death. Focal bone pain or recent trauma requires X-ray imaging: must rule out metabolic bone disease, tumor or fracture. Joint effusion with any sign of infection (redness, warmth, fever)… Continue reading Acute Monoarthritis