Emoticon game: Acute Liver Failure answers

If you haven't tried the emoticon game, check it out here: https://www.medicowesome.com/2020/12/emoticon-game-causes-of-acute-liver.html

The answers are posted below.

Emoticon game: Causes of Acute Liver Failure

 

Pediatrics Allergy & Immunology UWorld Step 2 CK

 

COVID-19 and the increased risk of Parkinson's disease

Hi!

Currently posted in psychiatry, I was reading articles on Parkinson's disease and came through this important finding in context with the coronavirus disease.

Cosmetic surgery and Nontuberculous Mycobacterial infections

There has been an increase in plastic surgery tourism because some countries offer cheap cosmetic surgery. Common surgical procedures sought are breast augmentation surgery, liposuction, eyelid surgery, facelift, labiaplasties, and gluteal lift procedures. [1]

Conus medullaris syndrome vs. Cauda equina syndrome

Both of these are orthopedic/neurosurgical emergencies! But in general, CM syndrome is more severe than CE syndrome.

Here's a comparison between the two...

Guidelines for management of gout by ACR 2020

 Hi!

Long time..

Urate-lowering therapy indications and important guidelines for management of gout, as updated by ACR in 2020:

TORCH syndrome + mnemonic

 TORCH syndrome is caused by congenital infection by a group of infectious agents. 

Respiratory fluoroquinolones

Why are moxifloxacin, gemifloxacin, and levofloxacin also known as respiratory fluoroquinolones?

Determining axis of EKG (isoelectric method) practice tracings

How to determine axis of EKG (number, isoelectric method) with mnemonic

Mechanical ventilation

Terms you need to know

1.       PaO2: Oxygen saturation in arterial blood  (N = 80-100)

2.       PaCO2: Carbon Dioxide saturation in arterial blood (N = 35 – 45)

3.       FiO2: Fraction of inhaled O2 (N = 21% i.e. the fraction of O2 in atmosphere air which we inhale)

4.       PEEP: Positive End Expiratory Pressure – The pressure needed at the end of expiration to keep the alveoli open.

5.       RR: Respiratory rate (N = 12-16)

6.       TV: Tidal Volume (N = 6-8 ml/kg = approx. 500 ml)

Shunt fraction and its importance

 Hello Awesomites! :D

When should you start sodium bicarbonate in CKD patients? Mnemonic

When should you start sodium bicarbonate in CKD patients?

Data Collection Methods

DATA COLLECTION METHODS

Neurology examination template

Hi everyone!

Here is my template for documenting the basic bare minimum neurology examination.

It's a Carny Problem

 Carney's Triad - ENCHONDROMA + PARAADRENAL GANGLIOMA + GIST

Carney's Syndrome - multiple benign tumors, mainly of heart and skin

Carney Stratakis Syndrome - Pediatric GIST (Gastrointestinal Stromal Tumor)

Shock by Dr. Ganti (Pulm/Crit)

 

Blood Donation

BLOOD DONATION

PRE-DONATION

HISTORY:

• Men can donate safely once every three months while women can donate every four months
• Age between 18 and 60 years
• The donor should be in a healthy state of mind and body
• Past one year - not been treated for Rabies or received Hepatitis B immune globulin
• Past six months - not had a tattoo, ear or skin piercing or acupuncture, not received blood or blood products, no serious illness or major surgery, no contact with a person with hepatitis or yellow jaundice.
• Past three months - not donated blood or been treated for Malaria
• Past one month - had any immunizations
• Past 72 hours - had dental work or taken Aspirin
• Past 48 hours - taken any antibiotics or any other medications (Allopathic or Ayurveda or Siddha or Homeopathy)
• Past 24 hours - taken alcoholic beverages
• Presently - not suffering from cough, influenza or sore throat, the common cold
• Women should not be pregnant or breastfeeding her child or menstruating.
• No diabetes, chest pain, heart disease or high BP, cancer, blood clotting problem or blood disease, unexplained fever weight loss, fatigue, night sweats, enlarged lymph nodes in armpits, neck or groin, white patches in the mouth, etc.
• No history of TB, bronchial asthma or allergic disorder, liver disease, kidney disease, fits or fainting, blue or purple spots on the skin or mucous membranes, received human pituitary - growth hormones, etc.

EXAMINATION:

• Temperature - Normal (oral temperature not exceeding 37.50 C)
• Pulse - between 50 and 100/minute with no irregularities
• Blood Pressure -Systolic 100-180 mm Hg and Diastolic 50 - 100 mm Hg
• Bodyweight - not less than 45 Kg
• Hemoglobin - not less than 12.5 g/dL-

Procedure to measure Hb using CuSO4:

i) Massage the finger to be pricked (preferably ring finger)

ii) Disinfect it

iii) Prick using disposable needle/ lancet

iv) Put the drop of blood in CuSO4 containing beaker

v) If the blood drop sinks, Hb is more than 12.5, hence the person can donate blood (provided no other contraindication).

PROCEDURE:

• Identify donor and label blood collection bag and test tubes
• Ask the donor to state their full name
• Ensure that:

1. the blood collection bag is of the correct type;
2. the labels on the blood collection bag and all its satellite bags, sample tubes and donor records have the correct patient name and number;
3. the information on the labels matches with the donor's information

• Select a large, firm vein, preferably in the antecubital fossa, from an area free from skin lesions or scars
• Clean the site of venepuncture by alcohol and let it dry
• Perform phlebotomy using a 16-gauge needle, which is usually attached to the blood collection bag. Use of a retractable needle or safety needle with a needle cover is preferred if available, but all should be cut off at the end of the procedure.
• Ask the donor to open and close the fist slowly every 10–12 seconds during collection
• Remove the tourniquet when the blood flow is established or after 2 minutes, whichever comes first
• Ask the patient to squeeze a ball intermittently during the procedure
• Monitor the donor and the donated unit
• Remove the needle and collect samples
• Cut off the needle using a sterile pair of scissors
• Collect blood samples for laboratory testing

POST-PROCEDURE:

DONOR CARE:

• ask the donor to remain in the chair and relax for a few minutes
• inspect the venepuncture site; if it is not bleeding, apply a bandage to the site; if it is bleeding, apply further pressure
• ask the donor to sit up slowly and ask how the person is feeling
• before the donor leaves the donation room, ensure that the person can stand up without dizziness and without a drop in blood pressure
• offer the donor some refreshments

BLOOD UNIT AND SAMPLES:

• Transfer the blood unit to a proper storage container according to the blood center requirements and the product
• Ensure that collected blood samples are stored and delivered to the laboratory with completed documentation, at the recommended temperature, and in a leakproof, closed container

REFERENCES:

http://naco.gov.in/blood-transfusion-services-publications

Written by our guest authors HARSH JOGI and AYUSHI GUPTA

Ascitic Tap

Requirements

Written informed consent, Betadine, Spirit, Sterile gloves, Sterile drapes, a 1.5-3.5 cm 20-22 G needle, a 5-20mL syringe is used, 18-20 G needle attached to a non-collapsible tube (can be made by breaking drip chamber of an IV set and putting one end of it in an empty water bottle for therapeutic tap tubing to a sterile collection bag)

Procedure:

1. Follow universal precautions. 

2. Skin around the site of puncture to be disinfected with betadine or Chlorhexidine and spirit and draped with sterile drapes.

3. Position: The patient should be in supine position( can be asked to roll slightly to left)

4. Site: a) At the junction of medial two-third and lateral one-third of the line join umbilicus and left Anterior superior iliac spine (left side is preferred over right to avoid damage to caecum)

OR 

b) 4 inches above iliac crest, whichever is more dependent

Site has to be lateral to rectus muscle. Avoid areas of scar.

5. Local Anaesthesia:

a) Skin, subcutaneous tissue, abdominal wall layers up to parietal peritoneum to be anesthetized with 2% lidocaine filled syringe using a 22-25 G needle.The needle is advanced into the subcutaneous tissue aspirating every 2-3 mm prior to injecting. 

b) Once a loss of resistance is felt and peritoneal fluid is drawn into the syringe, it indicates that we have entered the peritoneal cavity. Additional lidocaine is then injected to anesthetize the pain-sensitive parietal 

peritoneum. 

(A total of approx. 4-5 ml lidocaine is adequate.) 

c) The needle is then withdrawn. 

6. Puncture: 

For diagnostic tap – a 1.5-3.5 cm 20-22 G needle attached to a 5-20mL syringe 

is used. 

Technique – The aim is to prevent leak by ensuring the skin puncture site is 

not directly over the puncture site into the peritoneal cavity. 

 Z track technique – Pull skin about 2 cm downward before puncturing 

skin→ then leave the skin after entering few mm so as to form a Z

OR 

prick the skin, go for some distance in the subcutaneous plane and then change the angle to vertically downwards to enter the peritoneal cavity.  

For therapeutic tap - A large bore 1.5-2 cm 16-18 G needle is used instead.The syringe is detached and the needle is attached to a non-collapsible rubber tubing.The ascites fluid is drained slowly through the rubber tubing connected to the needle into a sterile collection bag. 

7. Seal : After the puncture, the punctured skin is sealed with a tincture benzoin 

seal. 

8. Post procedures: T.P.R, B.P to be recorded half hourly and the 

patient should not be given feeds for the next 4 hours. If there is pain, analgesics may be given.

- Mitali shroff