hannahjmiller14

Major dermatomes and cutaneous nerves - Anterior and Posterior Views #Diagnosis #Anatomy #Dermatomes #Dermatomal #Nerves #Roots #Cutaneous #neurology

Capnography and 12 Common Waves - Credit: Charlie Alvarenga #Diagnosis #CriticalCare #Capnography #Waveforms #Interpretation #ETCO2 #EndTidalCO2 #pulmonary

Delirium: Top Tips 1. LOOK CAREFULLY FOR DELIRIUM 2. HARNESS THE POWER OF THE FAMILY 3. FIND/STOP CULPRIT MEDS 4. ORIENTATE YOUR PATIENT Infographic by Dr. Linda Dykes @DrLindaDykes based on original document by Dr. Dan Thomas @dan26wales #Diagnosis #Management #Geriatrics #Delirium #Tips #Guidelines #PINCHME #Mnemonic

4-T Score for the Likelihood of Heparin Induced Thrombocytopenia - Thrombocytopenia - Compare the highest platelet count within the sequence of declining counts to the lowest. - Timing (of platelet fall or thrombosis) - Thrombosis - Other potential cause of Thrombocytopenia 0 to 3 points: Low probability (risk of HIT <1 percent) 4 to 5 points: Intermediate probability (risk of HIT ~14%) 6 to 8 points: High probability (risk of HIT ~68%) #4TScore #HIT #Heparin #Induced #Thrombocytopenia #Likelihood #Diagnosis #Hematology

The Cardiac Cycle Animated - Systole, Diastole, Pressures and Volume #Pathophysiology #Cardiology #CardiacCycle #Stages #Systole #Diastole #HeardSounds #Pressures #Phonogram #Electrocardiogram

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Antibiotic Considerations for the Medical Resident - Reference Cheatsheet Dr. Jesse Burk-Rafel @jbrafel #Antibiotics #Management #Cheatsheet #Pharmacology #Guide #Inpatient #Empiric

Hypothyroidism and Hyperthyroidism - Symptoms and Signs Hypothyroidism: - General - From asymptomatic to myxedema coma, “Like everything is slowed down” • Low exercise tolerance • Hyperlipidemia • Cold intolerance • Weight gain (modest) - Neuro • Depression • Memory loss • Fatigue - Face/Neck • Hair is coarse, brittle and is lost • Thinning of lateral 1/3 of eye brows • Puffy Face • Enlarged tongue • Hoarseness • ± Goitre - Cardiovascular • bradycardia • cardiomegaly • pericardial effusion • hypertension - GI • Constipation - Gu: • Menorrhagia - Skin • Skin is dry, coarse, thick, cold, pale - Muscles • Weakness, cramps • Tendon Reflex Delay (relaxation phase) Hyperthyroidism: - General “Like running a marathon all the time” • Appear to have high energy but are fatigued • poor exercise tolerance • Heat intolerance • Weight loss (despite appetite) - Neuro: • Nervousness • Restlessness • Insomnia • Tremour • Increased Reflexes - Face/Neck • ophthalmopathy ocular changes (periorbital swelling, lid retraction and lid lag, stare and infrequent blinking) infiltrative (proptosis/exophthalmos, increased edema of lids and conjunctiva, chemosis, ophthalmoplegia) • ± Diffuse goitre • Bruit (when osculating over thyroid) - Cardiovascular • Palpitations, Afib - GI • Diarrhea - Gu: • Infertility, amenorrhea - Skin • Sweating • Warm, moist skin • Dermatopathy Ø Hands: Acropachy Ø Legs: “pretibial myxedema - Amy Chung, MD, MSc @AmyChung #Hypothyroid #Hyperthyroid #Symptoms #Signs #Diagnosis #endocrinology #Hypothyroidism #Hyperthyroidism

Guide to Interpretation of Positive Blood Cultures I arrange the potential Gram stain results that one can be called w/ as follows: Gram(+) cocci, Gram(+) rods, Gram(–) rods, Gram(–) cocci, yeast. Gram(+) cocci are grouped by ‘morphology’ since the lab usually tells you this: clusters, pairs, chains, etc. Fill in with orgs. The orgs are deliberately ordered this way: Gram(+) orgs are often [skin] contaminants, Gram(–) orgs & yeast are not. Remember that clinician adjudication is the ‘gold standard’ for deciding what is a contaminant! Now, w/ the bugs organized, when you get that call from the micro lab, here are 3 questions to ask yourself/the lab: 1) Number of positive bottles/cultures and time to positivity? 2) ‘Shape’ of the bacteria? 3) Aerobic or anaerobic bottle? Fewer positive cultures & longer time to positivity suggests a contaminant. Apply Q1) to Gram(+) orgs. Time to positivity tough to interpret unless extreme (ex. 8h v 48h). Can use Number of positive cx fact to your advantage – before abx, obtain more cx & increase the denominator! Apply Q2) to Gram(+) rods since their shapes are so distinct. There are some uniquely shaped Gram(–) rods too, but rare (think Fusobacterium). Here’s a comparative chart of GPRs to illustrate. A great reason to go to micro lab and review the Gram stain! Apply Q3) to Gram(+) rods & perhaps Gram(–) rods too. For GPRs, preferential growth in the aerobic v anaerobic bottle helps organize the ‘shape’ chart. Ex: while you await speciation for that aerobic box car shaped GPR, these clues suggest Bacillus, usually a contaminant! For Gram(–) rods, the pearl is that Pseudomonas is a ‘strict’ aerobe and ought to grow preferentially in the aerobic bottle – thus, a GNR that grows in the anaerobic bottle first is less likely Pseudomonas. Of course, always exceptions to these pearls, so await speciation! Dr. Varun Phadke @ https://twitter.com/VarunPhadke2 #BloodCultures #BCx #Positive #Interpretation #Contaminant #Contamination #Interpretation #Laboratory #Microbiology #Diagnosis

Atrioventricular Blocks (AV blocks) - ECG Diagnosis Summary First Degree AV Block • The P wave is normal in morphology. • PR interval greater than 0.20 sec that remains constant. • The QRS is normal in duration or wide if there is an existing bundle branch block. Second Degree AV Block Type I aka Mobitz I / Wenckebach • Normal P waves. • The PRI progressively lengthens until a P wave is not followed by a QRS. • As the PRI lengthens, there is shortening of the RR interval. • The RR interval containing the dropped P wave is less than 2x of the shortest RR interval. • The PRI (may be normal or prolonged) of the first conducted P wave is shorter than the last conducted PRI. • The largest increment in the PRI is usually on the second conducted P wave. • There is "group-beating" on the ECG. Second degree AV Block type II (aka Mobitz II) • There is constant PR interval (normal or prolonged) before a P wave is dropped. • The QRS is usually widened because the location of the block is often infranodal. • The QRS complex maybe narrow indicating a more proximal location of the block (AV node). High-grade AV Block aka Advanced AV Block • During sinus rhythm, when 2 or more P waves are not conducted the term given is advanced or high-grade AV block. • The QRS may be wide or narrow. • This is a clinically concerning variant of Mobitz II and often implies advanced conduction disease and may progress to complete heart block. Third Degree AV Block aka Complete Heart Block • In sinus rhythm with complete AV block, the PP and RR intervals are regular but the P wave has no relationship with the R wave. • The PR interval varies because there is really no P and QRS relationship. • The ventricular rate is usually 40-60 bpm and narrow when it is driven by a junctional pacemaker (AV node). • The QRS is wide and less the 40 bpm when an infra-Hisian pacemaker takes over. Paroxysmal AV Block aka Ventricular Standstill • Abrupt and persistent AV block ( multiple P waves with no QRS) in the presence of otherwise normal AV conduction. • May be initiated by a conducted or blocked PAC or PVC, acceleration or slowing of sinus rhythm. • Once the block is initiated, the block will persist until terminated by an escape, usually ventricular, with a predictable relationship of the escape to the following P wave. #atrioventricular #blocks #AVBlock #cardiology #ekg #ecg #diagnosis #electrocardiogram #classification #summary

Causes of Hypokalemia - Differential Diagnosis Algorithm Once pseudohypokalemia is ruled out, causes of hypokalemia can be grouped into three discrete buckets: 1. Decreased filling of bucket (low intake) 2. Bucket that is leaky all over (transcellular shift) 3. Bucket with the drain wide open all the time (urinary or GI loss) - VARUN M @varunnephro #Hypokalemia #Differential #Diagnosis #Algorithm #Causes #workup #nephrology