Cholecystitis, cholangitis and Mirizzi's syndrome – A case report Case Presentation A 22-year-old male medical student with BMI 22 Kg/m2 presented to the outpatient clinic complaining of severe abdominal pain. The patient gave a history of multiple intermittent episodes of epigastric pain which started during his exams. He reported excessive drinking of caffeine during the last 3 months and these episodes were exacerbated mainly after eating fried food. The primary doctor prescribed omeprazole for a week, but there was no improvement. Pelvi-abdominal ultrasonography was performed and revealed calcular cholecystitis (Fig.
She still is dyspneic with exertion and on 2L of oxygen via nasal cannula. Uses a walker. • Mr. Raj Singh, a 68-year-old admitted with chest pain and scheduled to have a cardiac catheterization done today at noon. He is very anxious and rings the call bell every 15 minutes to ask whether he is going to die and if the cardiac catheterization is really necessary. • Mr. George Rivera, a 38-year-old Mexican male, admitted with high blood sugars and newly diagnosed with diabetes.
C: Unscreened population. O: Medication use (Statin, aspirin, antihypertensive and oral hypoglycemic agents), secondary test referrals, revascularizations, and cardiovascular events. Q: In asymptomatic patients, does screening with CCTA for coronary atherosclerosis compared to unscreened population reduce Medication use (Statin, aspirin, antihypertensive and oral hypoglycemic agents), secondary test referrals, revascularizations, and Cardiovascular events? 3. The PICO question in on the case we discussed in class.
The history of the headache An acute onset of the headache of the patient’s life associated with a stiff neck. Figure 3 CT-scan & MRI An ill appearing patient on physical examination typically lead the health care practitioner to consider the diagnosis and order a CT (computerized tomography) scan of the head. If the CT scan is performed within 72 hours of the onset of the headache it will detect 93% to 100% of all aneurysms. Figure 4 Lumbar Puncture In the few cases that are not recognized by CT the health care practitioner may consider performing a lumbar puncture to identify blood in the cerebrospinal fluid that runs in the subarachnoid space. Angiography If the CT or the LP reveals the presence of blood angiography is performed to identify where the aneurysm is located and to plan treatment.
Overall both the synthetic drug bath salts and crocodil result in damage to both the brain and body. The average lifespan for a crocodil user is 2 years while a bath salts user has a large chance of succumbing to an overdose after building up a tolerance. The drugs themselves have varying can be obtained with varying difficulty in the United States. One thing that is similar in both crocodile and bath salts is that the addiction can be treated through in-patient care involving the proper medical training and cognitive behavior
This type of anemia is mostly found in people with long-lasting problems like cancer, congestive heart failure, or inflammatory diseases. Based on the amount of your hemoglobin in blood, doctors rate the condition of your anemia. Doctors make use of this ranking of anemia with regards to the treatment although the signs that they have observed from you are not the same. When your hemoglobin is between 10 and is lower than the limit for your age and sex, it is classified as mild anemia. When your hemoglobin is 8 to 10 grams per deciliter, it is classified as moderate anemia.
• Tingling, numbness, and pain in the distal extremities due to peripheral nerve damage. • Weight loss. How is diabetes mellitus diagnosed? If you are experiencing these symptoms, it is important that you visit your primary care physician immediately. Some of the tests that will be ordered include glycated hemoglobin A1c test which measures the Hemoglobin A1c in your body (normal level is below 5.7) as well as fasting blood sugar test which measures the glucose level in the blood after fasting overnight (normal level is 100 mg/dL or 5.6 mmol/L).
For instance, drugs can be injected, swallowed, absorbed by skin or inhaled. They all get into the bloodstream and regulate it to all the parts of body within the receptors. The target receptors that can be divided into two which are agonist and antagonists. Agonist drugs is the activator for the receptor or stimulator which generate the level of the response in the cell. In contrary, the antagonist drugs act as the blocker the way of the body’s natural agonist and also they avoid cell response to agonist.
The most serious complication is nephrotoxicity, which may result in irreversible renal failure. Key management strategies for a cisplatin overdose involve renal protection and enhancing drug elimination, and consideration of sodium thiosulfate and plasmapheresis. A suggested algorithmic approach for the initial management of a patient with a cisplatin over-dose is presented in figure 2. To our knowledge, patients inadvertently receiving less than 300 mg/ m2 of cisplatin reportedly often recover, whereas overdoses exceeding 400 mg/ m2 frequently result in death. To our knowledge, our case is the youngest one who received a high dose of cisplatin (500 mg/m2) in the absence of intravenous hydration, and nephrotoxicity result in renal failure, hearing loss, visual impairment, severe myelosuppression complicated by life-threatening sepsis were presented in this patient.
The poorly perfused and hypoxic placenta is thought to synthesise and release increased amount of vasoactive factors including soluble fms-like tyrosine kinase-1 (sFlt-1), cytokines (interleukin-6 (IL-6), tumour necrosis factor (TNF-alpha), angiotensin II (ANG II) type 1 receptor antibodies (AT-AA) and thromboxane TX. Elevation in these factors are proposed to result in endothelial dysfunction by decreases in bioavailable Nitric Oxide (NO) and increased reactive oxygen species (ROS) and endothelien-1(ET-1), which in turn result in changed renal function, increased total peripheral resistance (TRP), and ultimately hypertension. PIGF is a placental growth factor and VEGF is a vascular endothelial growth factor. These are
An increase reading may elicit post-op infection. Cefazolin 1g IV 8 hourly for 7 doses are routinely prescribed post-op. Monitor electrolyte levels, especially potassium, magnesium, and calcium. Electrolyte imbalances are common causes of dysrhythmias and guide treatment. My patient was having regular Span K 1 tab TDS and the surgeon would add chlorvescent 2 tabs stat doses whenever required.
For example, less than one-half of the 2.5 million Americans aged 12 or older who abused or were dependent on opioids in 2013 received MAT with positive effects (Volkow, Frieden, Hyde, & Cha, 2014). Training on MAT needs to be expanded to providers to aid in decreasing the rate of overdose and abuse. The Substance Abuse and Mental Health Services Administration (SAMHSA) provides in depth detail as to where providers can receive this certification along with information on regulations and guidelines of the program. Oversight of treatment medications used in MAT remains a multilateral system involving states, SAMHSA, the Department of Health and Human Services (HHS), the Department of Justice (DOJ), and DEA (Legislation, Regulations, and Guidelines,
Monitor the heart rate and pattern Mr. Roberts has already developed sinus tachycardia with short runs of ventricular tachycardia, ST-segment elevation, T-wave inversion, and the development of Q waves over most of the anterior V leads on his electrocardiogram. The ST-segment elevation and the T-wave inversion indicate a possible Myocardial Infarction The low serum levels of potassium due to fluid shifting back to the intracellular compartments, the myocardium excitability increases resulting in tachycardia and abnormal EKG patterns Monitor fluid status Weight the patient daily This is the most accurate way to determine if the patient is retaining or losing fluid Strictly record Intake and Output Patient may develop dehydration due to all the water shifting to the interstitial spaces Maintain vascular volume Administer either D5W or hypertonic saline solution in order to pull fluids back into the vascular compartment. With lactic acidosis, lactated-ringers may be contraindicated. Monitor blood
(NSW Health 2012:20). Glyceryl Trinitrate acts on vascular smooth muscles and dilate arteries and veins. Vasodilatation results in the reduction of venous return which also reduces the work load of the heart and oxygen demand. GTN sublingual tablet or spray can be repeated every 5 minute for maximum of 3 doses. Regular monitoring of vital signs is important because GTN can cause Hypotension.
Review of systems is positive for heat/cold intolerance, skin rash, new growth or mole, snoring, ankle swelling, abdominal pain, nausea, muscle pain, muscle weakness and difficulty sleeping. As of this report, an 11-panel urine drug screen was administered on this visit and showed positive for oxycodone. Patient continues with failed back and radicular pain for several years and failing adjuvant and increasing tolerance. A second opinion was advised and proceed with surgery if needed, or a trial of spinal cord stimulator. Current request is for 150 Tablets of Percocet 10/325 mg between 6/20/2016 and