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ABSTRACT: Osteomyelitis is a common occurrence in children and typically has a prolonged treatment course involving multiple specialties. Historically, the long bones are most commonly affected and Staphylococcus aureus is the primary causative organism.This case shows the value of using the Kocher criteria and acute phase reactant C-reactive protein as diagnostic tools that can be used to advocate MRI to rule out this potentially devastating process.
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Osteomielitis , Infecciones Estafilocócicas , Antibacterianos/uso terapéutico , Niño , Humanos , Imagen por Resonancia Magnética , Osteomielitis/diagnóstico , Osteomielitis/tratamiento farmacológico , Estudios Retrospectivos , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/tratamiento farmacológico , Staphylococcus aureusRESUMEN
OBJECTIVE: This study evaluated the competence of Advanced Cardiac Life Support certified personnel at hands-on ACLS skills. METHODS: The observational, cross-sectional study assessed participants' subjective confidence and objective skills using the ACLS mega code examination. Testing was performed with a Laerdal manikin and standardized code carts. RESULTS: Participants had a 12% (6% to 22%, 95% CI) pass rate for the stable tachyarrhythmia scenario and a 57% (44% to 69%, 95% CI) pass rate for the unstable tachyarrhythmia scenario. The most significant skills missed were appropriate medications and postconversion maintenance in the stable scenario and appropriate energy selection and successful shock delivery for the unstable scenario. CONCLUSIONS: ACLS providers feel confident in their ACLS skills; however, actual performance demonstrated poor performance in the management of patients with stable and unstable tachyarrhythmias. The recommendation is to observe initial and recertification ACLS classes to investigate the standard to which these core skills are being taught and evaluated.
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Apoyo Vital Cardíaco Avanzado , Competencia Clínica , Estudios Transversales , HumanosRESUMEN
Physicians assistants (PAs) are being increasingly utilised by the US Armed Forces both in homeland medical treatment provision as well as while on deployment. In a deployed environment, the USA has the flexibility to interchange doctors with specialty-trained PAs in all roles of care due to their ability to practice autonomously, thereby filling shortfalls created by the lack of specialty physicians. PAs are increasingly being utilised within the UK National Health Service, in similar roles to their US counterparts. This paper postulates that PAs have an equivalent role to play in the future of medical care provision within the UK Defence Medical Services, including on military operations.
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Medicina Militar/métodos , Asistentes Médicos/tendencias , Alcance de la Práctica/tendencias , Humanos , Estados Unidos , Recursos Humanos/tendenciasRESUMEN
Glycogen storage disease is a rare congenital disorder that can lead to hypoglycemic events. This article focuses on a patient in acute distress secondary to hypoglycemia that failed to respond to initial interventions. Because symptoms can be similar to severe hyperglycemia, a thorough history and physical examination are key to prompt diagnosis and appropriate management.
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Enfermedad del Almacenamiento de Glucógeno Tipo I/complicaciones , Hipoglucemia/diagnóstico , Hipoglucemia/etiología , Adulto , Biomarcadores/sangre , Glucemia , Diagnóstico Diferencial , Femenino , Gluconeogénesis , Glucosa/administración & dosificación , Humanos , Hiperglucemia , Hipoglucemia/terapia , Inyecciones Intravenosas , Insulinoma , Resucitación , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE: The purpose of this study was to determine USAF physician assistants' (PAs') concerns regarding postgraduate education and training. METHODS: This was a single-mode, observational, cross-sectional study using an anonymous-structured survey involving a population of 420 active duty USAF PAs. Potential participants were contacted by email and asked to take a one-time survey via a secure survey site link. RESULTS: One hundred ten USAF PAs participated in the survey seeking their opinions on factors affecting applying for military postgraduate specialty training. The prime factors identified fell into 3 major groups of concern: types of degrees offered, current job satisfaction, and types of specialty training available. The most desired degree and specialty options were the doctorate of science and emergency medicine. Only a small number of respondents (6%) expressed current job satisfaction and the desire to remain in family medicine. CONCLUSIONS: This study revealed important information to senior leaders who fund, recruit, train, and maintain force-readiness requirements. The 3 identified main priorities of respondents were the types of degrees, current level of job satisfaction, and the types of specialty training. The vast majority of those surveyed preferred the doctorate, which is what all of the specialty degrees in the Air Force are, except for ENT.
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Actitud del Personal de Salud , Especialización , Estudios Transversales , Humanos , Satisfacción en el Trabajo , Personal Militar , Asistentes Médicos/educación , Estados Unidos , Equilibrio entre Vida Personal y LaboralRESUMEN
Abdominal aortic aneurysm (AAA) is a clinical challenge in risk assessment, recognition, treatment, and prevention. This article explores the pathogenesis, presentation, diagnosis, treatment, and prevention of AAA.
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Aneurisma de la Aorta Abdominal/terapia , Procedimientos Quirúrgicos Vasculares , Espera Vigilante , Factores de Edad , Angiografía , Aorta/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/diagnóstico , Aneurisma de la Aorta Abdominal/epidemiología , Aneurisma de la Aorta Abdominal/prevención & control , Aterosclerosis/epidemiología , Aterosclerosis/terapia , Enfermedad de la Arteria Coronaria/epidemiología , Humanos , Hiperlipidemias/epidemiología , Hiperlipidemias/terapia , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Imagen por Resonancia Magnética , Tamizaje Masivo , Factores de Riesgo , Conducta de Reducción del Riesgo , Factores Sexuales , Fumar/epidemiología , Cese del Hábito de Fumar , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
Patients with cancer are at higher risk for venous thromboembolism than patients without cancer due to hypercoagulability associated with malignancy. This article describes a patient with metastatic renal cell carcinoma who had chest pain over several weeks caused by multiple pulmonary emboli.