The Common Cold

31/01/2010

 

Viral infection of the upper respiratory tract

Etiology:
1.rhinovirus
2.parainfluenza virus
3.respiratory syncytial virus
4.coronaviruses
5.adenovirus

Modes of transmission/spread
1.Direct contact: person to person
most contagious in first 3 days of symptom onset
incubation period of 5 days

2.Indirect contact: viruses can survive more than 5 hours on the following:
fomites
skin
fingers touching contaminated surfaces then mucous membranes

3.Aerosoled
coughing
sneezing

Manifestations:
nasopharyngeal dryness and stuffiness
excessive nasal secretions
tearing at the eyes
typically clear and watery secretions
inflammation and erythmatous upper respiratory tract mucus membranes
sore throat
hoarseness
headache
generalized malaise
chills
fever
exhaustion

duration – 7 days

Diagnosis

Hx
symptoms, onset, duration

Treatment: OTC remedies

1.Antihistamines
used to dry nasal secretions
may act to dry bronchial secretions
may worsen cough
may cause dizziness, drowsiness and impaired judgment

2.Decongestants – sympathomimetic agents
constrict blood vessels to decrease swelling
may result in systemic vasoconstriction
may elevate blood pressure
should be avoided in those with HTN, heart disease, hyperthyroidism, diabetes

3.Vitamin C
studies show contradictory results
4.Zinc Lozenges – studies also show variable results


Sacred and Profound

30/01/2010

 

Sacred and profound

everything

surround

 

a cry of new life

and the silent apnea of death

 

life loved

life lost

and heart griping

breath-taking moments

revealed,

in between

 

listen carefully

for it is

echos

distant memories

so many of their stories

lives

in a rush

like water in a stream

chatters, gurgles

running along


Chondromalacia

30/01/2010

Abnormal softening or degeneration of cartilage.

May present as wearing away of the articular cartilage, common in the knee joint on the underside of the patella.


Maple syrup urine disease (branched-chain ketoaciduria)

29/01/2010

an autosomal recessive metabolic disorder.

Etiology:

 inability of the body to properly break down branched-chain amino acids (leucine, isoleucine and valine)

due to a deficiency of the branched-chain alpha-keto acid dehydrogenase complex

resulting in accumulation of these amino acids and metabolites to toxic levels within the body

Manifestations:

  • presence of sweet-smelling urine
  • poor feeding
  • vomiting
  • dehydration
  • lethargy
  • hypotonuria
  • seizures
  • ketoacidosis
  • opisthotonus
  • pancreatitis
  • neurological decline

Treatment:

  • monitoring of blood chemistry levels
  • diet low in the amino acids valine, leucine and isoleucine


Hirschsprung’s Disease (congenital aganglionic megacolon)

28/01/2010

 

congenital condition in which a section the colon is aganglionic

there is little urge to defecate so the feces accumulate.

  • genetic defect on Chr 10
  • 1/5000 live births
  • Sigmoid colon typically affected

 

  Mechanism:

  • absence of ganglia in parts of the colon
  • no peristalsis occurs in affected region
  • contents accumulate
  • colon becomes distended, in turn results in distended abdomen
  • bowel obstruction may occur

 

Treatment:

  • Surgical exision of aganglionic region

Dream of a Dream (Ngoc Nguyen)

27/01/2010

Dream of a dream
beyond all dreams,
beyond your wildest dreams
Dream of a dream
like you’ve never dreamed before,
dreams only you would dare to dream
and no one else


Total Knee Arthroplasty (replacement)

27/01/2010

A surgical procedure that replaces worn joint facets of the knee (proximal ends of the  tibia, fibula and distal femur) with a joint of man-made materials.


She knows you know. That is all

26/01/2010

 

When the beeper went off you were dreaming about running away from your
kid’s ball game and your job and your home.

On your way you review all the steps of pronouncement – you look for the
hospice death packet and think about what you will do and say.

They meet you at the door, quietly leading you to the room.

Everyone is silent, the lights are dim, they are waiting, expectantly.

On the hospital bed lies a skeleton – a shell of a person – pasty in color,
motionless. There is no heartbeat, no peripheral pulse, no respiration,
the eyes are open and fixed.

You wonder who this person was, what she was like when she was young,
what kind of suffering she endured. You tell the family that the patient has died.

The young girl begins to cry, her brother holds her, their mother – the patient’s
daughter – sits stoically next to the bed, hands folded in her  lap.

You stop the CADD pump and gently remove the sub-q catheter. You turn off
the oxygen concentrator and remove the nasal cannula. You excuse yourself
to make the phone calls.

The family sits next to their now gone grandmother – touching her hands, crying,
reassuring each other that they have done the best for her.

The daughter, the spine (pillar?)of strength, is not crying but gently
talking to her children.

You notify the doctor – he is sad, says he’s known her for 30 years, probably will
go to the funeral. You notify the minister who says he’ll be right there.

The funeral director will arrive in 30 minutes. The daughter witnesses for you as
you pour morphine and Percocet tablets into the toilet and flush. Paperwork.

The daughter tells you her mother suffered from cancer for 20 years off and on
- but that the last 3 months were fast and painful until the hospice nurses got the
pain under control with the CADD pump.

You calculate what the cancer must have occluded, eroded, robbed, to cause
such pain. There is cachexia. There are pedal contractures.
The abdomen is grossly enlarged.

You tell the daughter the good things you see – how beautifully the skin has been kept,
not a hint of breakdown; how nice the hair looks, such an obvious sign of the love
and devotion her mother has received.

The two young children leave the room and you and the daughter bathe the mother
one last time, change the linens, and make her comfortable.

You talk to each other and to the body. The daughter begins to cry – you hold her,
like the child she is at this moment – the child who no longer has a mother.

The doorbell rings, the funeral director has arrived. You encourage the daughter and
her family to come into the dining room and have a cup of tea. You go back to the
bedroom to assist with the transfer of the body into the funeral bag.

Such finality when the zipper goes over the face – you want to keep the family
delicately away from the sight of this. It is painful enough for you.

The minister arrives. The family gathers in the living room. They thank you for
being there and for giving up your sleep in their hour of  need.

You pack the loose medical supplies, strip the bed, break it down, gather the
trash, turn out the bedroom light, and close the door. The equipment company
will come in the morning for the larger supplies. You say good-bye and leave.

Outside, alone in your car, you cry.

A few months later at a mutual friend’s wedding, you see the daughter.
When she sees you she smiles with sadness in her eyes.

You smile back. She knows. You know. She knows you know. That is all. That is enough. 

On Call (Anonymous)


The Gamma Nail

26/01/2010

The Gamma nail was designed to treat unstable intertrochanteric and subtrochanteric fractures.

 The device was developed after cadaver studies and has been used clinically since 1985.

 The Gamma nail transmits weight closer to the calcar than does the dynamic hip screw and it has greater mechanical strength.

A semi-closed operative technique is used, with an average duration of operation of 35 minutes and little blood loss. Distal locking screws can be used to maintain rotational stability.

Wheeless, Clifford R. Weeless’ Textbook of Orthopedics.


The Strength of the Human Spirit.

25/01/2010
Dreams come true
because someone believes
they can, and without
thought of failure, they risk
everything they have within them.
Hopes are always renewed because
someone won’t give up, and they
don’t allow the risks involved to
keep them from taking a chance.
Wishes that seem so impossible
can be wished for anyway, and they
will come into reality because of
simple faith.
Faith is the one thing in life
that can take you through any
pain, relieve any worry or sorrow,
and keep you believing in the joys
of tomorrow.
Faith is the ability to believe in
the idea that good will eventually
come from the worst possible
situation, pain, or disillusionment. 

It carries us through bad
times with a deep sense of
security and strength, and the
knowledge that whatever might
come, we possess the ability to
overcome any obstacle, overlook
obvious discouragements, and
keep on trying through any
disappointment.
Faith is the one thing in life
that you’ll always need, because
the strength you possess… is the
strength of the human spirit.

-author unknown


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