45 year old male with history of Hep B ( Hep B Surf Ag + but Hep E Ab+ and E Ag – and DNA viral load was not sent) and syphilis treated in the past. He has RPRs in the past that were 1:1 for years and then negative x 2 a year apart, the last being over two years ago. He had labs drawn last week and had an RPR of 1:4. He does report high-risk unsafe sexual activity (with female prostitutes) over the past two years. He does not recall seeing a chancre and his exam was negative. He has not tested for HIV.…
The NYU Langone Online Journal of Medicine
1. clinical cases with difficult management questions answered by faculty members
VA MICU Conference 11/22/06
56 y.o. male with PMH ETOH abuse and COPD presented with a LUL PNA and BCx positive for penicillin-resistant pneumococcus.
Early Goal-Directed Therapy in Severe Sepsis and Septic Shock
- Early broad spectrum antibiotics.
- Goal directed hemodynamic resuscitation with
- IV fluids
- PRBCs (for Hct <30)
- To maintain:
- Central Venous Pressure 8-12 mm Hg
- Arterial Pressure: MAP >65 mm Hg but <90 mm Hg
- Central Venous Oxygen Saturation >70%
- Consider cosyntropin stimulation to evaluate for relative adrenal insufficiency.
If you notice on the right side of our home page on the sidebar is a scroll of updating news items from Medpage Today. Everytime you log into clinical correlations the sidebar is updated with the latest news. This site, originating from the University of Pennsylvania is one of the best ways to keep on top of breaking medical news. Everyday you can receive an email from the site which lists headlines from major media outlets, including major medical journals and international meetings. The summaries are well written and then reviewed by physicians. The price is free as long as you can bear with the targeted drug advertising……
Welcome to Fast Facts-a new feature of Clinical Correlations. Look for frequent posts summarizing key teaching points from Morning Reports and Noon Conferences from Bellevue, Tisch and the VA.
Bellevue 11/16/08-William Slater M.D.
34 yo female, 4 weeks post-partum, presents with progressive DOE, othopnea, and bilateral pleural effusions on CXR. Working DDx: Postpartum Cardiomyopathy, PE, Primary Pulmonary HTN TTE with normal EF, right ventricle dilatation, and PAP >50 mmhg..…
Reperfusion via thrombolytics or PCI in patients with acute STEMI has been shown to reduce mortality and maximize myocardial salvage. It has been less clear whether patients with late presentations of MI are afforded the same benefits.…
Commentary by Deborah Shapiro, M.D. Attending Physician, Dept. Veterans Affairs
Over the last few weeks there has been major press in the lay media about this lead article in the NEJM from 10/26/06. …