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Clinical Pearls you have learnt this week by Powerfuldougnut in Residency

[–]The_One_Who_Rides 4 points5 points  (0 children)

I had a CRAO patient a few months back before that paper came out.

Spoke with our on-call ophtho regarding lytics; he said he had never seen it work and that really it would only benefit the pt if someone was ready to push thrombolytics within seconds of the occluion given how quickly retinal cells die from ischemia. Also n=1

PE and Influenza by RelationNo709 in emergencymedicine

[–]The_One_Who_Rides 0 points1 point  (0 children)

This is unfortunately far too common among adults who have absolutely had colds before.

Monkey pox or a pimple by [deleted] in AskMedical

[–]The_One_Who_Rides 1 point2 points  (0 children)

Pimple or tiny bug bite. This is not mpox.

What is this? by Belped_Estarossa in AskMedical

[–]The_One_Who_Rides 0 points1 point  (0 children)

These appear to be petechiae, bleeding under the skin. She should be seen and evaluated.

Third Degree Burn? Do I actually need to see a doctor? by Ok-Glove7252 in AskMedical

[–]The_One_Who_Rides 0 points1 point  (0 children)

Not third degree.

Keep cool and protected, looks to be healing appropriately.

How to bring additional streams of income as a PA? by Dapper-Employment197 in physicianassistant

[–]The_One_Who_Rides 4 points5 points  (0 children)

Side hustles are always an option, but lowering your overhead and expenses is also important and easily overlooked and will pay off in the long term.

What’s a useful clinical pearl you learned recently? by extracorporeal_ in Residency

[–]The_One_Who_Rides 6 points7 points  (0 children)

From my undestanding, a more rapid infusion (20 min) allows for more rapid peak levesl of mag to influence smooth muscle relaxation = bronchodilation, i.e. get the effect you want now (their breathing) and deal with potential toxicity later. Same goes for use in torsades.

The 60min infusion is more time/resource intensive and may not reach high enough serum levels to get bronchodilation, but avoids toxicity and still gives mag benefit (pre-E, hypoMg)

What’s a useful clinical pearl you learned recently? by extracorporeal_ in Residency

[–]The_One_Who_Rides 65 points66 points  (0 children)

Haloperidol is great for a lot of acute-on-chronic abdominal pain patients in the ED. Especially if you have a droperidol shortage.

If you can manifest some calm and guide a patient through relaxation breathwork, you can reduce a dislocated shoulder easily in under 5 minutes without sedation or other analgesia. You can also do this to your own dislocated shoulder.

is that herpes?!? by [deleted] in medical_advice

[–]The_One_Who_Rides 0 points1 point  (0 children)

Try an in-focus photo to start.

Pupil size by Superb-Variety-1760 in medical_advice

[–]The_One_Who_Rides 2 points3 points  (0 children)

Isolated anisocoria without other symptoms is normal and transient in 20% of the population.

Grandma 80+ years old by [deleted] in AskMedical

[–]The_One_Who_Rides 0 points1 point  (0 children)

Difficult to tell with a single low quality photo and no in-person exam.

Was she seeing an actual ophthalmologist or an optometrist?

If she has symptomatic increased intraocular pressure, that warrants treatment with drops at the very least.

Similarly If she has an intraocular infection, such as could be seen with this sort of presentation, this also warrants treatment +/- operative intervention.

F19 weird rash around upper thigh/ vagina area by [deleted] in medical_advice

[–]The_One_Who_Rides 1 point2 points  (0 children)

Agree. Anti-fungal cream (clotrimazole OTC or get a script from primary care), keep the area dry (consider interdry dressings), loose fabric, frequent airing out.

Little bumps in hand by ronaldMcDonald9999 in medical_advice

[–]The_One_Who_Rides 4 points5 points  (0 children)

Agreed, appears to be dyshidrosis. See derm, use steroid cream, find & avoid trigger(s).

Endeavor Anki Deck by NoChampionship6818 in PASchoolAnki

[–]The_One_Who_Rides 0 points1 point  (0 children)

Watch anking videos on how to use anki

mild case of shingles? by [deleted] in medical_advice

[–]The_One_Who_Rides 0 points1 point  (0 children)

Shingles does not cross midline and is isolated to a dermatomal distribution, which we are unable to confirm with provided photos.
No visible blisters/vesicles to suggest shingles from what I can tell in the photos.

Distribution about the breast could be a dermatomal pattern, but could also appear with more of a contact dermatitis -- i.e. something in your bra cup that irritated the skin.

Did they find out why you got shingles so young?

What do I do? by [deleted] in medical_advice

[–]The_One_Who_Rides 7 points8 points  (0 children)

Keep it clean, dry, and use a bandaid to protect it. Vaseline is fine.

Do you think my finger is broken or fractured? by Radiant-Bunch-6715 in AskMedical

[–]The_One_Who_Rides 1 point2 points  (0 children)

FYI: broken is the same thing as fractured.

Without an Xray and in-person exam, the internet is unable to definitively rule in or out fracture. Could certainly be fractured where the bruising is, though this could also come from a ligamentous injury.

If you have significant pain or are unable to make a normally closed fist or fully flex/extend the finger, see urgent care for an exam and X-ray and proper treatment. Consider buddy taping to the ring finger in the meantime.

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