Unbounded Medicine

The following pictures are from different clinical cases.

In Blunt Trauma the spleen and the liver are injuried in 40 and 20 percent, respectively.

In the ER, you have three four options in the Work-Up of a patient with blunt abdominal trauma

• Peritoneal Lavage: Now just performed if you haven’t access to ultrasound (lack of money or lack of trained personnel). It’s indicated in specific cases, as in patients with cranial trauma, spinal trauma, for example.

• Ultrasound (a.k.a. FAST or Focused Abdominal Ultrasound for Trauma): This is one of the most used techniques, and should be performed for those patients hemodynamically unstables who can’t go to the coputed tomography room.

• Computed Tomography: This technique has a magnific resolution for spleen, liver and vessels. Excellent evaluation for retroperitoneum. It has one inconvenience, hemodinamically unstable patients are not candidates for this analysis.

• Diagnostic Laparoscopy: Almost never recquired.

The controversy is when the hospital is not capable of performing the standarized protocol in blunt abdominal trauma (economic reasons), we doctors have to adequate to the circumstances and do our best effort.

For example, the first two photographs (peritoneal lavage) were taken at the Mexican Red Cross where money is the big problem. The rest, were taken at the ABC Medical Center, a nice private hospital. This are the contrasts of healthcare system and medicine practice in developing countries.

Regards,

Dr. Jon Mikel Iñarritu

With new look, new content and new features appears the new ePOCRATeS Rx.

I’ve been trying this brand new version of ePOCRATeS and I think that it’s quite better than the previous version.

The main features are:

• My Epocrates personalized homepage
• Go straight to the drug monographs you recently viewed
• Create shortcuts to get to your favorite applications faster
• Launch MobileCME activities in your specialty
• Edit your profile

• New drug safety content
• Therapeutic Drug Levels
• Monitoring Parameters
• Non-Interchangeable Forms
• Pregnancy and lactation information

• New decision support tools
• Corticosteroid Converter
• Narcotic Analgesic Converter
• Heparin Dosing Protocol
• INR Calc
• Topical Corticosteroids

• Memory Card support (this is nice)
• More than 3,300 brand and generic drug monographs, searchable by name or class
• Peer-reviewed drug content summarized from a wide range of authoritative sources
• MultiCheck drug-interaction checker (30 drugs simultaneously)
• Integrated health insurance formularies
• MedMath* medical calculators, e.g., Body Mass Index, Creatinine Clearance
• Ability to personalize the application to suit your needs
• DocAlert messaging — relevant, timely clinical and specialty news
• AutoUpdate

Give it a try.

Regards,

Jon Mikel Iñarritu, M.D.

With a “very cheap” subscription rate of $995 (OMG!!) you can have access to Access Surgery, inside you can find this stuff:

• Surgical Videos: Columbia University College of Physicians and Surgeons Surgical
• Animations: Adapted from Zollinger’s Atlas of Surgical Operations, 8th Edition
• Textbook: Schwartz’s Principles of Surgery, 8th Edition
• Textbook: CURRENT Surgical Diagnosis & Treatment, 12th Edition
• Surgical Atlas: Zollinger’s Atlas of Surgical Operations, 8th Edition
• Surgical Anatomy: Skandalakis’ Surgical Anatomy
• Board Review: Surgery Review Illustrated
• Quick Answers: CURRENT Consult Surgery Table of contents (see the image below).

Special Features:

• Create your own Board Review test from Surgery Review Illustrated, then email results to your program director
• View Surgical Videos on your iPod from the Schwartz editorial team
• Look up a symptom or disease in our Differential Diagnosis (DDx) tool
• Download the free PDA diagnostic tool from CURRENT Consult Surgery
• Assess the extent of disease through Cancer Staging Tables
• Discover related Government Guidelines by clicking a pre-populated search box
• Launch a Customized Search for just videos, just images, or view full-site results
• Research medication indications, dosages, and contraindications through an integrated Drug Database provided by Gold Standard.

The site was launched on July 18th.

Will you pay for this material? (It’s a question, because I don’t)

Regards,

Jon Mikel Iñarritu, M.D.

In the next couple of weeks I will be updating this site (style, layout, design, features).

From time to time there could be errors on displaying its new features or contents.

So please feel free to report any inconvenience when you are browsing Unbounded Medicine.

Thanks.

Update 07/24/06: While we finish the design, I will be posting on regular basis.

Here is a video of an ATLS maneuver on an air ambulance.

Regards,

Jon Mikel Iñarritu, M.D.

Yesterday at Health-Hack.com they made a list of six of the most evident symptoms of some serious illness, via WebMD:

From WebMD:

1. If you have unexplained weight loss and/or loss of appetite, you may have a serious underlying medical illness.

2. Slurred speech, paralysis, weakness, tingling, burning pains, numbness, and confusion are signs of a stroke, and you should get to an appropriate emergency center immediately. Early treatment may prevent permanent damage to the brain or even save your life.

3. Black, tarry stools may indicate a hemorrhage from an ulcer of the stomach or the intestine. It is important to stop the bleeding and to rule out cancer as a cause.

4. A headache accompanied by a stiff neck and fever is an indicator of a serious infection called meningitis.

5. A sudden, agonizing headache, more severe than any you have felt before, could mean you are bleeding in the brain. Go to an emergency room immediately.

6. For women: Vaginal bleeding after menopause is a waning sign of possible cancer.

6. For men: A lump in your testicle with or without a small lump in the groin could be serious. Testicular cancer is more commonly found in testicles that did not naturally descend from the abdomen to the scrotum.

Via Lifehacker.com

I’ve been asked –and consulted- about “rare chest pain” in several times. I could notice that people is always worried about any kind of chest pain because the fear of suffer a heart attack or a pulmonary problem. Chest pain is one of the most common symptoms that require medical attention. You –as physician- should always exclude this topics (cardiac and pulmonary) in the first place. You should keep in mind that there is a disease called costochondritis (Tietze’s syndrome) once you ruled out the main fear conditions (pulmonary and cardiac).

Costochondritis is an inflammation of the costo-sternal joint (rib-sternum) or it could be an inflammation between the costo-chondral joint (rib-rib cartilage). The group mainly affected is that woman over 40s.

Etiology (causes): Direct injury to the chest, viral infections (cold / flu), idiopathic (the cause cannot be found).

Its clinical manifestations: Pain, tenderness in those joints I already mention earlier. This pain and/or tenderness get worse when you touch the involved site or move in a certain direction.
The diagnosis it’s mainly a clinical one and the physician should always exclude a heart attack and other important things.

The gold-standard of treatment is NSAIDs (non-steroid anti-inflammatory drugs like aspirin, diclofenac, naproxen, ibuprofen, acetaminophen, etc.) for one or two weeks (this disease usually lasts for this period of time). Some patients respond well to putting a local heating pad.

You have to remember that when you have chest pain, you have to look for a health care provider immediately to exclude other serious conditions.

Regards,

Jon Mikel Iñarritu, M.D.

Spanish (Español) article

A previously healthy 17 yo woman came in to the ER because she has suffer an automovilistic accident. On the initial evaluation she was with pulse ‘parvus et tardus’ with altered mental status. A chest x-ray was ordered and found an aortic rupture.

Because the bleeding was contained and she has just a little hemodynamic instability, the choice was endovascular treatment of traumatic thoracic aortic rupture.
A CT Scan was ordered preoperatory:

Endovascular Procedure

After Procedure

The outcome was excellent and the patient is in good shape rightnow with a normal lifestyle.

Regards,

Jon Mikel Iñarritu, M.D.

A 76 years old female comes to the emergency department because shortness of breath. She has been postrated since 2 months ago, when she wasn’t able to move her legs anymore. Shortness of breath since 1 week ago (NYHA IV). She states that she has “rheumas”. She gives no other information. She has been taking methotrexate since 4 years ago, in interval periods of time, she doesn’t know which doses. On physical examination you note a postrated elder woman with severe physical deformities. You also found this:

This is an extremely advanced case of rheumatoid arthritis. But, what associations with pulmonary disease does RA have? What kind(s) of pulmonary disease(s) does this patient have (or could have)?