Curbside Consult Thread

[doctorcoug]

Codes due to trauma equal DOA. Cardiopulmonary arrest from blunt trauma means you are done, it isn't like an arrest due to MI, the injuries that go with the trauma are too devastating.

Fournier's gangrene smells bad, good night.

Dude, your on the other side of the table with that stinky mess. It smells worse when the patient is in lithotomy and your right there between it all.

via a galaxy s3 far far away

[San Juan Sun]

A question today:

"Is my thyroid so big because of oral sex?"

[Mormon Red Death]

A question today:

"Is my thyroid so big because of oral sex?"

Lol...

Sent from my SGH-T839 using Tapatalk 2

[doctorcoug]

Mammography isn't working?

This is kind of a boggling article...hitting me like the PSA/Htn and BP meds/Hld and statins stuff over the last couple of years. We knew about diagnosis creep as well as overdiagnosis (all too obvious with the PSA tragedy). I've stated on here that breast cancer is highly politicized and that the money we spend on it could be better spent on heart disease reduction. Well, radiologists and oncologists aren't going to like this and I've already seen absolutely flagrant and almost lying editorials from physicians about this stuff (the NYT). Prepare for the journal wars.

I'm fairly certain, though, that my medical school will continue its annual "boozin for boobies" drive.

BACKGROUND
To reduce mortality, screening must detect life-threatening disease at an earlier, more curable stage. Effective cancer-screening programs therefore both increase the incidence of cancer detected at an early stage and decrease the incidence of cancer presenting at a late stage.
METHODS
We used Surveillance, Epidemiology, and End Results data to examine trends from 1976 through 2008 in the incidence of early-stage breast cancer (ductal carcinoma in situ and localized disease) and late-stage breast cancer (regional and distant disease) among women 40 years of age or older.
RESULTS
The introduction of screening mammography in the United States has been associated with a doubling in the number of cases of early-stage breast cancer that are detected each year, from 112 to 234 cases per 100,000 women — an absolute increase of 122 cases per 100,000 women. Concomitantly, the rate at which women present with late-stage cancer has decreased by 8%, from 102 to 94 cases per 100,000 women — an absolute decrease of 8 cases per 100,000 women. With the assumption of a constant underlying disease burden, only 8 of the 122 additional early-stage cancers diagnosed were expected to progress to advanced disease. After excluding the transient excess incidence associated with hormone-replacement therapy and adjusting for trends in the incidence of breast cancer among women younger than 40 years of age, we estimated that breast cancer was overdiagnosed (i.e., tumors were detected on screening that would never have led to clinical symptoms) in 1.3 million U.S. women in the past 30 years. We estimated that in 2008, breast cancer was overdiagnosed in more than 70,000 women; this accounted for 31% of all breast cancers diagnosed.
CONCLUSIONS
Despite substantial increases in the number of cases of early-stage breast cancer detected, screening mammography has only marginally reduced the rate at which women present with advanced cancer. Although it is not certain which women have been affected, the imbalance suggests that there is substantial overdiagnosis, accounting for nearly a third of all newly diagnosed breast cancers, and that screening is having, at best, only a small effect on the rate of death from breast cancer.

[San Juan Sun]

I've been in enough ORs in enough states to certify this universal truth: things happen in the OR only in conjunction with the OR/anesthesia staff breaks.

[doctorcoug]

Ahh, I love dictation. Here is what I said:

"Patient runs cows during the summer"

Here is what was transcribed:

"Patient runs gals during the summer"

[Katy Lied]

I'm kinda curious, how many vaginal exams does one undergo from a family medicine physician before she realizes something is cooky?

[dabrockster]

Look for some advise. Not sure what to do..


This past weekend I ended up in the ER. I had a sore throat that became very severe and about 2 AM I had a 102 temp with sever aches and pains. I took 6 ibuprofen to see if I could get my temp down but after an hour it was still up.

I thought I had the flu but ended up negative but positive for Strep throat. The gave me Amoxicilin (2 pills a day for 14 days) along with a 600 MG iburpfen for pain. I began to take my pills and since then have had a severe stomach problem. I am not sure how to explain it but I feel like food is caught in the lower part of my throat and have the urge to burp often. When I do burp directly afterward I have this severe pain in my upper stomach (Almost like gas/bloated) that last for roughly 5 seconds or so. It happens when I drink, eat etc. It has been constant ever since. My stomach feels like it is in a minor knot throughout the day as well.

Could the medicine cause this? Or do I have some esophagal problem that needs to be addresses. It is not heartburn. It is completely different in that feeling.

Any help would be greatly appreciated. I haven't eaten or taken my medicine today because of it..

[ERCougar]

Look for some advise. Not sure what to do..


This past weekend I ended up in the ER. I had a sore throat that became very severe and about 2 AM I had a 102 temp with sever aches and pains. I took 6 ibuprofen to see if I could get my temp down but after an hour it was still up.

I thought I had the flu but ended up negative but positive for Strep throat. The gave me Amoxicilin (2 pills a day for 14 days) along with a 600 MG iburpfen for pain. I began to take my pills and since then have had a severe stomach problem. I am not sure how to explain it but I feel like food is caught in the lower part of my throat and have the urge to burp often. When I do burp directly afterward I have this severe pain in my upper stomach (Almost like gas/bloated) that last for roughly 5 seconds or so. It happens when I drink, eat etc. It has been constant ever since. My stomach feels like it is in a minor knot throughout the day as well.

Could the medicine cause this? Or do I have some esophagal problem that needs to be addresses. It is not heartburn. It is completely different in that feeling.

Any help would be greatly appreciated. I haven't eaten or taken my medicine today because of it..

The ibuprofen definitely could. Have you taken it before?

Switch to Tylenol and see how you feel. Really, you could stop the amoxicillin as well--we completely overtreat strep--but don't tell your doctor I told you that.

[Pelado]

Look for some advise. Not sure what to do..


This past weekend I ended up in the ER. I had a sore throat that became very severe and about 2 AM I had a 102 temp with sever aches and pains. I took 6 ibuprofen to see if I could get my temp down but after an hour it was still up.

I thought I had the flu but ended up negative but positive for Strep throat. The gave me Amoxicilin (2 pills a day for 14 days) along with a 600 MG iburpfen for pain. I began to take my pills and since then have had a severe stomach problem. I am not sure how to explain it but I feel like food is caught in the lower part of my throat and have the urge to burp often. When I do burp directly afterward I have this severe pain in my upper stomach (Almost like gas/bloated) that last for roughly 5 seconds or so. It happens when I drink, eat etc. It has been constant ever since. My stomach feels like it is in a minor knot throughout the day as well.

Could the medicine cause this? Or do I have some esophagal problem that needs to be addresses. It is not heartburn. It is completely different in that feeling.

Any help would be greatly appreciated. I haven't eaten or taken my medicine today because of it..

Just stop eating, drinking, and burping.

[The_Douger]

Look for some advise. Not sure what to do..


This past weekend I ended up in the ER. I had a sore throat that became very severe and about 2 AM I had a 102 temp with sever aches and pains. I took 6 ibuprofen to see if I could get my temp down but after an hour it was still up.

I thought I had the flu but ended up negative but positive for Strep throat. The gave me Amoxicilin (2 pills a day for 14 days) along with a 600 MG iburpfen for pain. I began to take my pills and since then have had a severe stomach problem. I am not sure how to explain it but I feel like food is caught in the lower part of my throat and have the urge to burp often. When I do burp directly afterward I have this severe pain in my upper stomach (Almost like gas/bloated) that last for roughly 5 seconds or so. It happens when I drink, eat etc. It has been constant ever since. My stomach feels like it is in a minor knot throughout the day as well.

Could the medicine cause this? Or do I have some esophagal problem that needs to be addresses. It is not heartburn. It is completely different in that feeling.

Any help would be greatly appreciated. I haven't eaten or taken my medicine today because of it..

It could be gastritis from the antibiotics as well. Amoxicillin just doesn't agree with some people. Have you ever had any problems like this with ibuprofen previously?

[dabrockster]

I stopped the iburprofen 2 days ago. Still taking the Amoxicilin since saturday. I have never had a problem with amoxicilin before or any medicine for that matter..

You think I should be good now to stop the amoxicilin then? No longer have a sore throat at all.

[ERCougar]

I stopped the iburprofen 2 days ago. Still taking the Amoxicilin since saturday. I have never had a problem with amoxicilin before or any medicine for that matter..

You think I should be good now to stop the amoxicilin then? No longer have a sore throat at all.

Antibiotics for sore throat decrease the duration of symptoms by a few hours over placebo. The rationale for antibiotics is the prevention of rheumatic fever, a disease we haven't seen in this country for a really long time, and there is real question as to whether or not the current strains of Group A Strep are even capable of causing it (the recommendation is based on some pretty substandard research done in military barracks in the 1950s, I think). Rheumatic fever is really only dangerous in its potential to cause valvular heart disease, something that only occurs in about 1/3 of cases. All in all, I've seen numbers showing that you're more likely to die from an allergic reaction to the penicillin used to treat strep throat than you are to contract valvular heart disease.

We do it out cuz it's just the way things are done.

(Stop the amoxicillin...off the record, of course. Try some OTC antacids to help your abdominal pain)

[dabrockster]

Antibiotics for sore throat decrease the duration of symptoms by a few hours over placebo. The rationale for antibiotics is the prevention of rheumatic fever, a disease we haven't seen in this country for a really long time, and there is real question as to whether or not the current strains of Group A Strep are even capable of causing it (the recommendation is based on some pretty substandard research done in military barracks in the 1950s, I think). Rheumatic fever is really only dangerous in its potential to cause valvular heart disease, something that only occurs in about 1/3 of cases. All in all, I've seen numbers showing that you're more likely to die from an allergic reaction to the penicillin used to treat strep throat than you are to contract valvular heart disease.

We do it out cuz it's just the way things are done.

(Stop the amoxicillin...off the record, of course. Try some OTC antacids to help your abdominal pain)

Thank you so much for the help. I will go get some antacid's now and stop the amoxicilin.. Hopefully this will clear it up..

[doctorcoug]

Dude, you've got the flu.

via a galaxy s3 far far away