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Medical Case Presentation

Transcript: Boulanger David medicine student Medical case presentation Identity Identity Name: Johnson Forname: William DOB: 24th September 1979 Occupation: Teacher (school director) Social status: Married Child: 2 (girl: 12 boy: 8) Live in: Grenoble (France) Symptom(s) Symptom(s) - Dizziness - Headache - Muscle aches - Insomnia - Nausea and vomiting - Irritability - Loss of appetite - Swelling of the hands, feet, and face - Rapid heartbeat - shortness of breath with physical exertion - Coughing - Chest congestion - Pale complexion and skin discoloration - Inability to walk or lack of balance - Social withdrawal Family history (FH) Family history (FH) TIME FATHER: myocardial infarction (67) MOTHER: Diabetes (32) Siblings: NAD Past medical history Past medical history TIME appendectomy (14) tonsillectomy (15) withdrawal of wisdom teeth (18) Broken leg (23) Social history (SH) Social history (SH) TIME Walking Trekking Climbing Swimming Skiing Examination (O/E) Examination (O/E) examination (O/E) examination (O/E) Weight: 70 Size: 1.75 Weight: 70 Size: 1.75 BP: 140/80 BP: 140/80 P: 180 P: 180 Respiratory frequency 20 / Min Respiratory frequency 20 / Min P02: 92% P02: 92% T: 37.5°C T: 37.5°C DIAGNOSIS DIAGNOSIS Acute Mountain Sickness (AMS) ? Acute Mountain Sickness (AMS) Treatment Treatment Medications : acetazolamide, to correct breathing problems blood pressure medicine lung inhalers dexamethasone, to decrease brain swelling aspirin, for headache relief Other treatments Lower altitude Lower altitude At rest At rest Water Water

Medical Case Presentation

Transcript: O God, that men should put an enemy in their mouths to steal away their brains! That we should with joy, pleasance, revel, and applause transform ourselves into beasts! William Shakespeare (1564-1616) British poet and playwright. 48 year old Caucasian female "My stomach is really hurting" HPI 48 y/o lady with a PMH of alcoholic liver cirrhosis, and esophageal varices "My stomach really hurts" She's been having abdominal pain for the past 6 days. Describes the pain as dull (constant and diffuse) 8/10 in severity starting from the epigastrium moving to the lower part of the belly. She feels relief when she lies down and worse sitting up. She also mentions that she noticed gradual distention of her belly for the past three weeks. She denies any nausea, vomiting, weight loss, or fever but notices some swelling in her left leg. In addition, she has recently been experiening some shortness of breath. She has dyspnea on exertion but denies orthopnea and paroxysmal nocturnal dyspnea. Of note, she mentions that she had similar belly pain 2 weeks ago which was associated with episodes of bloody vomiting. She went to Eastern Shore Hospital, admitted for upper GI bleed, underwent a panel of tests that included an endoscopy, ultrasound, and ascitic tapping and diagnosed with liver dx. She also mentions that she felt a lot better after that and hoped to get tapping done at SAH. Past Medical History Alcoholic liver cirrhosis Grade one esophageal varices Anemia Hx of thrombocytopenia Anxiety disorder GERD Cholecystitis Alcohol abuse Past Surgical History Rhinoplasty Allergies Acetaminophen (rash) Oxycodone (nausea) Medications Propanolol 10 mg po BID Pantoprazole 40 mg po BID Lactulose 15 mg po Qday Spironolactone 25 mg po Qday Sertraline 100 mg po Qday Clonazepam 1 mg po BID Review of Systems General: Muscle weakness, fatigue, and chills HEENT: No headaches, vision change, hearing changes, sinus troubles, bleeding gums, swollen glands Cardiac: No chest pain, palpitations Resp: Cough (non productive) and wheezing Breasts: No lumps, pain, nipple discharge GI: per HPI GU: No trouble urinating, no pain on urination, no hematuria, LMP was three years ago Extremities: per HPI Skin: No rashes, lesions, or color changes Endocrine: No heat or cold intolerance, excessive thirst or hunger Neuro: No seizures, numbness, or tingling Hematologic: No easy bruising or past transfusions Physical Exam 99.0 T 76 P 18 RR 115/60 BP 97% on 2L nasal cannula Weight: 70.307 kg General: Middle aged lady, in obvious pain but no acute respiratory distress, alert and oriented to person, place, and time. HEENT: Scalp normal, pupils equally round and reactive to light and accomodation. Fundoscopic exam reveals normal vessels, tympanic membranes are normal, oral pharynx is normal, neck is supple, no abnormal adenopathy in cervical or supraclavicular areas, thyroid is normal without any masses. Cardio: No murmurs/rubs, heart sounds S1 and S2 are present. Resp: Decreased air entry over the rt lower lung field, some expiratory wheezing bilaterally. GI: The abdomen is distended and bulging at the flanks but not tense, diffuse tenderness to palpation exquisitely over the epigastrium, Murphy's sign not present, bowel sounds are present, positive for shifting dullness, liver palpable 2 fingers below the subcostal margin, unable to appreciate exact size of liver or any splenomegaly MS: No cyanosis, clubbing, or edema noted. Peripheal pulses in the dorsalis pedis, and radial arms are normal. Skin: Multiple spider angiomas over subclavicular region, face and shoulders Neuro: Alert, oriented x3, CN II-XII intact, power 5/5 all extremities. March 10: Hypoxic requiring 100%FIO2 and PEEP of 12. March 11: Breathing improving requiring PEEP of 5 and FiO2 of 40%. Renal function improving with the CVVHD March 12: Breathing treatment the same, worsening encephalopathy, sedated but arousable, does not follow commands this am, eye opening present. CT of abdmn showed mild ascites, possible ascending colitis. Displaying multiorgan failure. March 13: Family decides to change code to DNI/DNR and request pt to be extubated with pastoral services present. March 14: Pt displays agonal breathing, no longer arousable. On morphine drip for pain. March 15: Worsening agonal breathing, no longer arousable. On morphine drip for pain. March 16: Pt passes away at 6:21pm. SBP Spontaneous bacterial peritonitis (SBP) is an acute bacterial infection in the peritoneum and severe consequence of ascites. Patients with cirrhosis who are in a decompensated state are at the highest risk of developing spontaneous bacterial peritonitis. Patients at greatest risk for spontaneous bacterial peritonitis have decreased hepatic synthetic function with associated low total protein level or prolonged prothrombin time (PT). The diagnosis is established by a positive ascitic fluid bacterial culture and an elevated ascitic fluid PMN count >250 cells/mm3 SBP Fever and chills occur in as many as 80% of patients.

Medical powerpoint

Transcript: Characteristics Earn a doctor of medicine (M.D) 4 years of medical school 3 years of general pediatric training (intern or resident) Going into the medical field is going to be a difficult challenge but with determination I will achieve my goal. With some of the experience I already have it will give me a jump start into the medical field. Pediatrician: I am 16 years old my favorite sport is swimming I want to get into a prestigious medical school some of my strengths are: I am very ambitious and this program would be a great opportunity for me. I am a team player and i am happy to work with other people on a project I am very hard working. I put a lot of efforts into what I do and I do my best Master's degree Bachelor's degree in nursing 1-2 years of experience Class of 2017 Health Career Academy Exploration Education plan Registered nurse University of Irvine Salary: $70,590 yearly $33.94 hourly Claudia Lopez period 1 Who am I? My future Skill set Work well with others I know my medical terminology words I know my vital signs Medical abbreviations i am very sociable Want to go straight to a 4 year university I am CPR certified I have completed my 100 hours of externship I have experience in a clinic Nurse practitioner a nurse who is qualified to treat certain medical conditions without the direct supervision of a doctor. $96,460 yearly $46.37 hourly Registered nurse: Education Plan My future Earn a bachelor's of science in nursing (BSN) 4 years at a university 2-3 years to achieve pathway Lesson learned Claudia Lopez Nurse practitioner: Pediatrics Enjoy working with kids $173,000 yearly $74.00 hourly Health Career Academy

Medical Powerpoint

Transcript: Nature Of Work Very similar, yet different compared to an EMT paramedic- a specialized trained medical technician licensed to provide a wide range of emergency services before or during transportation to a hospital this includes assessing the patients condition and determine a course of treatment EMT- a specialized trained medical technician certified to provide BASIC emergency services before or during transportation to a hospital life or death situations often arise work can be physically strenous and stressful can give medication orally and intravenously interprets elecotrocardiograms (EKG`s) used to monitor heart function equipment :monitors, complex equipment, backboards, restraints etc. Work environment inside and outside spend most of their time standing, kneeling, bending and lifting Can work in helicopters with flight crew training/qualifications/advancment must be licensed in the state where the job is held must take 8 hours of training to drive ambulance EMT- 200-250 hours of classroom instructions, skills practice in a laboratory, hospital emergency room and ambulance experience a field internship may become an instructor, a registered nurse, a physician or any other type of healthcare worker Job outlook 33% The number of EMT and Paramedics needed in Florida will grow at an annual average growth rate of 2.4% which is equivalent to 227 openings until the year 2014. Earnings Median is 35,849 per year Bonus: $49 Paramedic located in Orlando, Fl The lowest: 10% 28,090 25% 31,788 75% 40,527 90% 44,705 Related occupations Air Traffic Controllers- coordinates the movement of air traffic to ensure that planes stay safe distances apart Firefighters-protect the public by reponding to fires and other emergencies, they are often the first responders on the scene of an incident Physician Assistant-practice medicine under the direction of physicians and surgeons Police and Detectives- protect lives and communites, gather facts and collect evidence of possible crimes Registered Nurses- provide and coordinate patient care, educates patients/public on various health conditions and provide advice and emotional support OTHER INFORMATION Important Qualities: Compassion Interpretation Skills Listening Skills Physical Strength Problem solving skills Speaking skills Their are four levels of Emergency Medical Technicians (EMT`s) : First Responder, EMT-Basic, EMT-Intermediate, and EMT-Paramedic. Detection Reporting response On scene care Care in transit Transfer to definitive You most likely have heard of a military paramedic. They are actually simply called medics. Now do you think you've heard that name before? They fly helicopters, planes, and are their in the midst of battle to support their fellow comrades. Unpaid volunteers are being replaced by paid professionals. GRAPHIC IMAGES!!! •There are about 700,000 EMS personnel in the country. employment change for 2010-2020 is 75,400 PARAMEDIC Star of life: •50% of EMT Basics are on volunteer status. Emergency Medical Technician- 2 year associates degree in emergency medical services technology is available Your salary income depends upon your experience and which state you reside in. paramedics attend large sporting events and public gatherings most work at least 50 hours a week but are on call for extended periods of time only 50% of EMT/ Paramedics actually work in ambulances others work in hospitals, other government facilities etc •70% of all EMS personnel are male and 76% are white. •The origin of the word ambulance is from the early 19th century French words meaning 'mobile (horse-drawn) field hospital' - hôpital ambulant. Ambulant is a Latin term for 'walking'. must be certified as basic EMT before becoming a Paramedic 3/4 of people that go to school to become a paramedic graduate Top 5 paying states for Paramedics: •Hawaii •Alaska •Maryland •Oregon •Washington 1,100-1,500 hours of instruction and experience that includes classroom instructions, clinical rotations in hospitals, a field internship aboard an ambulance and laboratory experience By: Nichole Moroz •EMT`s treats approximately 25-30 millions people each year. Paramedic symbol

Medical Case Presentation

Transcript: Medical case presentation Ahmed Arab Medical intern Case: Case A 70 year old male patient A.A admitted to ER on the 1st of April complaining of hematemsis & bleeding per rectum since the day before C/O on admission History - Hematemsis - bleeding Past Medical history Past medical history Liver cirrhosis attributed to past bilharzial infection History esophageal & fundal varices History of rectal varices & hemorroids TIME Past Surgical history Past Surgical history Multiple Upper Gi Endoscopy with both endoscopic band ligation and sclerotherapy for gastric varices Colonscopy (LGIE) and rectal varices injection by histoacryl last performed on 14th of march TIME Examination (O/E) Examination (O/E) General Examination (O/E) examination (O/E) A,C,O Weight: 70 Size: 1.75 BP: 110/70 BP: 140/80 P: 110 P: 180 ABG : PH :7.52 Respiratory frequency 20 / Min PCO2 : 28 P02: 92% HCO3 :28.9 T: 37.5°C Local examination PR : Bleeding per rectum Local examination Recurrent hematemsis and bleeding per rectum after admission led to drop in HB Interventions so the patient recieved a transfusion with both RBCs and FFP CBC D.D Diagnosis - Rectal varices - hemorrhoids - Distal colon cancer - Diverticular disease Most likely diagnosis: Portal hypertension caused by liver cirrhosis complicated by upper and lower GI varices Investigations Investigations on day of admission Blood work Hb :8.9 Platlets: 137 WBCs: 18.05 Pt : 17.3 Pt activity : 50% INR : 1.53 total bilirubin : 1.7 albumin 3.3 creatine 1.5 BUN 22 CT abdomen &pelvis relevant findings CT - cirrhotic liver changes - portal htn in form of: *distended PV(2.4 cm) with near total occlusion by a thrombus extending to right & left main branches *splenomegaly (18 cm) *multiple portosystemic collaterals * mild Ascites - Gall bladder with thick walls and multiple stones indicating CCC - Hyperdense nodes seen in rectum consistant with the history of rectal varices injection with histo acryl Management of rectal varices Manage-ment Endoscopic management - Endoscopic band ligation -Endoscopic injection sclerotherapy Endoscopic Interventional radiology - Transjugular intrahepatic portosystemic shunt (TIPS) - Embolization of the feeding vessel to the rectal varices -Balloon-occluded Retrograde Transvenous Obliteration (BRTO) Interventional radiology surgical mangement - Direct suture ligation - Inferior mesenteric vein occlusion and porto-caval shunt surgery surgery

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