n****a
发帖数: 2525 | 1 Thanks everyone for replying.
It's been 12 days into her hospital stay, she is still in pain. Her IgG4 to
look for autoimmune pancreatitis was negative, lab ordered for possible
Celiac (which leads to poor absorption of Levothyroxine and pancreatitis
link) also negative. GI still thinks pancreatitis, might have been
exacerbated by cold meds she was taking that has some ETOH content. EGD was
done by GI only showing gastritis. CT ab showed nothing but cysts, no
pancreatic cyst or pseudocyst or oth... 阅读全帖 |
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s**********t
发帖数: 217 | 2 What does she ask for pain? Dilaudid? You get the answer. Did you check her
UDS at adm? |
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n*******c
发帖数: 501 | 3 D-Dimer
这个问题争论已久，现实是诊断PE最主要还是靠临床先评估risk，如果临床上一点都不
支持PE，那就宁愿不做，因为你知道negative不会改变结局，positive你也不会因此CT
，反而费尽心机解释，不如不做。high risk的你知道即使negative你也不放心最终也
是要CT的那就不如不做。所以order之前一定要自己能说服自己这个病人postive我就
orderCTA而negative我就不做CTA才行。
上面这个病人我是order了的，主要是因为我太想给她一个机会不做CTA的...这个病人
risk 主要是pregnancy和immobile due to RUQ pain，像“林海雪原”大哥说的，如果
doppler negative且d-dimer negative，我不会那么着急order CTA，除非临床上又发
生了变化比如血氧掉了或haemodynamically unstable，不过那样的话可能查不查也不
重要了，床边超声木有dissection就直接上heparin了... |
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s********o
发帖数: 3319 | 4 顶一个！没想到newprozac也这么能写!!!
一入院已经把所有检查包括腹部超声肝功能什么的都做了，确认没有问题的）
pregnancy要找个d-dimer阴性的只怕还不容易呢。
out PE, also to investigate the cause of chest pain…patient is
dimer and increased A-a gradient although a negative leg doppler…”我陪着小
心的解释. |
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d********y
发帖数: 616 | 5 我无语了。Shame on this 放射科的值班医生! ！他/她 out了。估计很长时间没有追
文献了或继续教育了。不知道Ruby同不同意我的观点。
另补充两点：
1，我们实验室的多中心前瞻性的关于PE的文章多篇马上就要发表了。这是基于多中心的临床大样本的NIH项目。希望到时留意。
2，PE时之所以会引起诊断的混淆，是因为扫描时间窗技术员掌握的不好。因为肺动脉的扫描要比其他器官的扫描要快，但是一旦太快又会造成血管显影不佳的问题。Radiology上有发表的相关文章公布了计算扫描延迟时间的经验公式或修正公式。有的时候，bolus tracking 技术在肺动脉扫描时不能work very well.
一入院已经把所有检查包括腹部超声肝功能什么的都做了，确认没有问题的）
pregnancy要找个d-dimer阴性的只怕还不容易呢。
out PE, also to investigate the cause of chest pain…patient is
dimer and increased A-a gradient although a negative leg doppler…”... 阅读全帖 |
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A*******s
发帖数: 9638 | 6 Wow, you made it！ 特别是在有阻力的情况下坚持自己的观点， 太赞了。
Private radiologists一般不会说no， 除非他们要下班什么的。 在academic可能是另
一回事， 以理服人是根本， 谁都有犯错的时候， always be diplomatic， not to
be dogmatic。
很喜欢你的总结，没想到newprozac不鸣则已， 一鸣惊人啊。
一入院已经把所有检查包括腹部超声肝功能什么的都做了，确认没有问题的）
pregnancy要找个d-dimer阴性的只怕还不容易呢。
out PE, also to investigate the cause of chest pain…patient is
dimer and increased A-a gradient although a negative leg doppler…”我陪着小
心的解释. |
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f*********1
发帖数: 189 | 7 An old patient with PMH of laryngeal cancer, now presents with left upper
quadrant pain. What differential diagnosis is on your list?
A lot of Pictures are going to come back later. |
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l**********p
发帖数: 189 | 8 IV tramadol? Transdermal fentanyl is contraindicated for postoperative pain |
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f****o
发帖数: 2770 | 9 IV tramadol is only available in Europe not US
pain |
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f****o
发帖数: 2770 | 10 因为我压根就没管她做了啥手术，我也不是学手术的。
她就是做了某我记不得的手术，术后PACU回来直接住在regular floor了（没去SICU什
么的）
然后NPO24小时
术后她就叫疼，给了针hydromorphone说有hallucination再也不要了，要别的药。。。
我是负责verify你们医生发过来的order的药剂师。然后gyn/onc的一年级intern就给开
meperidine 12.5mg IV啊，护士还催呢。虽然不是最好的option，但是我真是想不出有
啥办法了。发了个email给pain team问问，他们也不给个答案，就说meperidine不让用
止痛。
这个事情都发生了两次了，我真是没辙了。 |
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A*******s
发帖数: 9638 | 11 Can you provide me a link?
pain |
|
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f****o
发帖数: 2770 | 13 mind if i ask, where do you practice? we know the potential side effect of
meperidine so we don't give it for pain when there are better options
effect |
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A*******s
发帖数: 9638 | 14 Why are you guys so scared of demerol? It does cause seizure because of its
metabolites but as long as you know what you are doing, it is safe.
I would never bother to use morphine if it causes hives.
Patch is good for chronic pain related to cancer.
I
's |
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L****n
发帖数: 12932 | 15 Without knowing what kind of surgery, there is no way to optimize pain
control. Npo 24hr would make me think this is not just a oophorectomy.
Seems to me fentanyl patch is the best option. |
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L****n
发帖数: 12932 | 16 In this case, the best pain management is probably an epidural placed before
surgery - if she had a anesthesiologist who is good with epidural placement
handling her case. If the patient is on anticoagulant for some reason and
epidural is off limit, a single injection of intrathecal duramorph can be
considered. If none can be done, a low strength fentanyl patch can be used
for this patient. |
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L****n
发帖数: 12932 | 17 to A+: Demerol, ie meperidine, is the weakest among all narcotics. it's
generally not enough for post pain. mostly given for shivering - which is
very effective. |
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l**********p
发帖数: 189 | 18 Duramorph is still morphine which might cause allergies.
Iontophoretic fentanyl would work for postoperative pain, however Ionsys was
pulled off the market because of some design defects.
before
placement |
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A*******s
发帖数: 9638 | 19 Naive, never been exposed.
Regarding that contraindication, it only means fentanyl patch could cause
respiratory depression. What opioid does not do that? Nil.
When you are out of options, you have to use what you think is the best for
the patient. You are not supposed to leave CANCER patient in pain.
daily
oral
8
equianalgesic
. |
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A*******s
发帖数: 9638 | 20 I could not understand why you think one opioid is way more dangerous than
the other? They are all dangerous in terms of respiratory suppression. It
only depends what the dose you are going to use and how.
For this patient, I just proposed demerol im as a bridge for acute pain
then considering her cancer status, a patch would be in her best interest if
she still remains NPO.
the |
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B******y
发帖数: 2255 | 25 更新下
(Based on data from optionpain.com.)
Feb 18 updates:
AAPL: 495
AMZN: 185
BIDU: 135
CMG: 380
SPY: 135
其实关键是它的数据和算法可靠否。当然OE 时的价格可以跟option pain不一样，也没
法说什么。还有就是option的交易量中有不少市场换手而非新合同，还有用每天的收盘
价和实盘成交价也有区别。
总之，是很难验证。 |
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S***a
发帖数: 1072 | 26 各位给推荐个看 OPTION MAX PAIN的网站吧，先谢了...... |
|
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A**********i
发帖数: 780 | 28 Cindy从两岁左右就偶尔抱怨膝盖疼。但是好像不影响她活动。医生给看过也没查出什
么来。昨天带她去了gym, 结果夜里居然醒了说膝盖疼，直哭。我给揉半天也不管用，
后来冷敷了一下，才又睡着了。今天早上又没事了。我上网查了一下好像最有可能是
growing pain. 没什么可治的，不知谁听说过这个东西没有。犹豫要不要去看骨科。 |
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j****e
发帖数: 1782 | 29 包包这个膝盖疼一直是on and off
有阵子厉害的时候去查过血
也没有查出关节炎的问题
估计就是growing pain了 |
|
c****t
发帖数: 1103 | 30 //哦？我听医生说膝盖疼得话可能不是growing pain,但如果摸起来更疼得话，可能就
需要作检查 |
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y***o
发帖数: 228 | 31 我们老大时不时也说腿疼，不过看她跑跑跳跳也没事，看来也是growing pain乐 |
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g****n
发帖数: 1786 | 32 网上科普说，如果有back pain要睡firm mattress. 为这，我这次买mattress的时候特
地弃plush换firm了。睡了几天，原来不疼的地方都疼了。是不是需要一个适应的过程
？ |
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l*****r
发帖数: 7130 | 33 特别硬的mattress会导致back pain。
我朋友当年就是买了硬的又换软的。 |
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g*2
发帖数: 658 | 34 这个要慎入。有问题，查个关键词，看看。
SPECIFIC INJURIES
Hip injuries
Overview and approach — Hip injuries are less common in runners than
injuries to the lower extremity and they can be difficult to diagnose.
Nevertheless, during jogging, the hip joint is subjected to loads up to
eight times body weight and both acute and chronic injuries can occur [55].
In runners, the differential diagnosis of hip pain includes gluteus medius
tendinopathy, piriformis syndrome, stress fracture of the femoral neck,
labral tear, a... 阅读全帖 |
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p********3
发帖数: 5750 | 35 INTRODUCTION — The word "acupuncture" is derived from the Latin words "acus
" (needle) and "punctura" (penetration). Acupuncture originated in China
approximately 2000 years ago and is one of the oldest medical procedures in
the world.
Over its long history and dissemination, acupuncture has diversified and
encompasses a large array of styles and techniques. Common styles include
Traditional Chinese, Japanese, Korean, Vietnamese, and French acupuncture,
as well as specialized forms such as hand,... 阅读全帖 |
|
i*****s
发帖数: 15215 | 36 ☆─────────────────────────────────────☆
ellieo (改，改，改，改你个猫！) 于 (Sat Mar 23 22:09:53 2013, 美东) 提到:
话说，为啥flickr的照片贴过来没问题，picasa的我就死活也贴不上来……
这两天闲着没事儿的时候，罗罗嗦嗦的码了一堆的字，顺带弄了点图，结果悲剧的发现
，这里flickr传不上去东西……本来想贴点以前的在picasa上面存的图，结果发现
picasa的图片贴不上来，sigh……嘛，先把罗嗦的小故事发上来好了，基本属于流水账
外加感慨一类的，偶尔出现一点实用信息……
在南美洲大陆的南端,有一片被狂风眷顾的土地Patagonia.在Patagonia荒原上,不论是
大树还是小草,通通都是一边倒的歪着长的.不过,这里有着仅次于南北极冰川的世界上
第三大的冰川Hiela Sur,有着贯穿南美洲且孕育着西半球最高峰的Andes山脉,还有着在
荒原上悠然吃草的Guanaco,以及翱翔在高空俯瞰着荒原的Andean Condor.于是,对我来
说,这里似乎有着一种特别的魔力,吸引着我一次又一... 阅读全帖 |
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k*****e
发帖数: 22013 | 37 【 以下文字转载自 ChinaNews 讨论区 】
发信人: pipigou123 (鼠姐虎弟), 信区: ChinaNews
标 题: Re: 在美国，学中医的比这里大部分人赚得多
发信站: BBS 未名空间站 (Sun Aug 14 19:55:23 2011, 美东)
INTRODUCTION — The word "acupuncture" is derived from the Latin words "acus
" (needle) and "punctura" (penetration). Acupuncture originated in China
approximately 2000 years ago and is one of the oldest medical procedures in
the world.
Over its long history and dissemination, acupuncture has diversified and
encompasses a large array of styles and techniques. ... 阅读全帖 |
|
D****R
发帖数: 6053 | 38 DAVID GREENE, HOST:
On a Monday, it's MORNING EDITION from NPR News. I'm David Greene.
STEVE INSKEEP, HOST:
And I'm Steve Inskeep.
Today in Your Health, we report on the most common reasons people go to the
doctor: back pain. More than 1 of every 4 adult Americans say they've
recently suffered a lower back pain, and that figure is on the rise.
Billions of dollars are spent every year treating that problem. But many
specialists say less medical treatment is usually more effective.
As part of our ... 阅读全帖 |
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q********u
发帖数: 15519 | 39 人物简介
编辑
美国疼痛学专家 阮秀禄(Xiulu Ruan)医生简介： 生于济南，1982 年就读于山东医科
大学医学系(英语班),88 年毕业. 1989年赴美深造，接受了临床医生全面正规的训练,
先后在美国麻省Worcester Medical Center内科任实习医生(internship),在威斯康星
医学院(Medical College of Wisconsin)附属医院理疗与康复科任住院医生(residency
), 在密执根大学University of Michigan (Ann Arbor) Health Systems 麻醉科-介入
治疗疼痛医学中心接受了研究生专科培训(Fellowship)，通过了八项医学专业/亚专业
特考文凭考试，成为美国医学界持有最多特考文凭的医生， 激励着海外医学学子为实
现自己的梦想而奋斗。
2人物生涯
编辑
创立并刷新世界纪录
学无止境，是阮秀禄医生的座右铭. 基于对病人的高度责任感及对技术精益求精的工作
作风, 阮医生刻苦学习，努力钻研, 以惊人的毅力,通过了艰辛的考试，以其拿下8项美
国医学专业/亚专业特考文凭(Board/S... 阅读全帖 |
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U******u
发帖数: 5829 | 40 shyj: 我的考版match路--以此文纪念在美国逝去的10年青春
http://mitbbs.com/pc/pccon_2289_t379_150975.html
发信人: shyj (baobao), 信区: MedicalCareer
标 题: 我的考版match路-以此文纪念在美国逝去的10年青春 (很长很罗嗦，慎入！）
发信站: BBS 未名空间站 (Sat Apr 3 17:31:55 2010, 美东)
Match的结果终于尘埃落定，周1等电邮的时候非常紧张，因为成败就在此了，虽然一直
告诉自己，今年只是热热身，成败都可以接受，但到真的揭晓的时候，还是很紧张，毕
竟一旦卷入其中就身不由己，何况自己也还是有所付出。到周4等match program的时候
虽然也有点紧张，但程度已经大大减少，1个原因是毕竟match上才是头等大事，去哪里
尚在其次，还有1个原因是心理还是有所准备了，虽然希望留在home school，但直觉告
诉我恐怕是非常困难了，在我rank list上第二位的program应该就是我要去的地方，果
不其然。经过几天的等待，发现果然是要搬家了。
对于我... 阅读全帖 |
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s********o
发帖数: 3319 | 41 【 以下文字转载自 MedicalCareer 讨论区 】
发信人: herby (小臭宝), 信区: MedicalCareer
标 题: [合集] 你有生以来做出的最佳临床诊断是什么？
发信站: BBS 未名空间站 (Thu Jun 2 00:01:26 2011, 美东)
☆─────────────────────────────────────☆
Aplusplus (Hakuna Matata) 于 (Sun Mar 27 11:11:49 2011, 美东) 提到:
首先我申明，我放弃我的ignore list， 欢迎所有ID参加。
每个医生护士或者其他相关人员， 无论在中国还是美国， 肯定都有一些case刻骨铭心
。 请大家把你印象最深的一例写出来， 与大家分享。 比方说， 清华男被鉈杀案，
那个中国来的护士就是诊断的关键， 相信本例就是她一辈子也忘不了的诊断。
我觉得这样的讨论有助于大家提高学医热情，丰富医学知识，开拓临床思维， 间接帮
助考版医生复习，准备CS，和 interview. 你要是能从中挑一个case让你PD
impressed，我想我的... 阅读全帖 |
|
s********o
发帖数: 3319 | 42 【 以下文字转载自 MedicalCareer 讨论区 】
发信人: herby (小臭宝), 信区: MedicalCareer
标 题: [合集] 你有生以来做出的最佳临床诊断是什么？
发信站: BBS 未名空间站 (Thu Jun 2 00:01:26 2011, 美东)
☆─────────────────────────────────────☆
Aplusplus (Hakuna Matata) 于 (Sun Mar 27 11:11:49 2011, 美东) 提到:
首先我申明，我放弃我的ignore list， 欢迎所有ID参加。
每个医生护士或者其他相关人员， 无论在中国还是美国， 肯定都有一些case刻骨铭心
。 请大家把你印象最深的一例写出来， 与大家分享。 比方说， 清华男被鉈杀案，
那个中国来的护士就是诊断的关键， 相信本例就是她一辈子也忘不了的诊断。
我觉得这样的讨论有助于大家提高学医热情，丰富医学知识，开拓临床思维， 间接帮
助考版医生复习，准备CS，和 interview. 你要是能从中挑一个case让你PD
impressed，我想我的... 阅读全帖 |
|
发帖数: 1 | 43 11 月13日 终于找到另一股在我家害我的势力
昨天，这些人折腾了一天，白天，晚上皮啦啦，也不知道谁把谁杀了，谁把谁带走了。
反正我先生和孩子被绑架了，就不知道是不是已经遇害了。我本来是打算睡觉的，但他
们头上，地下装电磁波攻击器，让我几乎窒息。虽然我没倒下，但其实他们在我身上扎
的毒针已经蔓延，我能感觉到我的呼吸有窒息的感觉。我想我对他们已经非常仁慈了，
但他们不依不饶地攻击我，欲置我于死地，让我非常生气，特别是肆意伤害我家里的人
，绑架我先生和孩子，而且有许许多多无辜的生命毁于他们之手，有必要把他们曝光。
当然我还没分析这里边是那几个人具体攻击我，伤害我的，但他们显然都是一伙的。鉴
于他们伤害我的头部，胸部 和胃部，我就把这几部分的医生都曝光，受害者慢慢去调
查，追查他们吧。
Cleveland Clinic, Website: my.clevelandclinic.org
Call 855. REFER. 123 or 855.733.3712
Lung Cancer
Results: 57 Doctors
PREV123NEXT
Results per page:
Dav... 阅读全帖 |
|
e****0
发帖数: 678 | 44 • Exaggerated deep tendon reflexes can be seen in lock in syndrome.
• Non bleeding varices are managed with nonselective beta-
adrenergic antagonists, such as propranolol.
• Sclerotherapy, endoscopic band ligation, and surgery are
indicated after a patient has a first episode of variceal bleeding.
• TIPS is a last resort in variceal bleeding unresponsive to
medical and endoscopic intervention.
• Ischemic colitis
CT—thickening of eth bowel ... 阅读全帖 |
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d******0
发帖数: 296 | 45 Case 1
Opening scenario:
Sharon Smith, a 48-year-old female,comes to the clinic complaining of
abdominal pain. Married with four children.
Vital signs:
BP:135/70 mmHg
Temp:98.5 F
RR:16/minute
HR:76/minute, regular
Protocol:
Knock three times with confidence, a smile, walk in and say:
Good morning, Ms Smith. I am Dr. Dora, and I am here to see you today as
your physician. Nice to meet you .Shake hands. Is everything in the room
alright for you? Let me cover you with this to make you a little m... 阅读全帖 |
|
m******r
发帖数: 1904 | 46 ☆─────────────────────────────────────☆
dora2010 (dora) 于 (Wed Feb 29 16:55:46 2012, 美东) 提到:
Case 1
Opening scenario:
Sharon Smith, a 48-year-old female,comes to the clinic complaining of
abdominal pain. Married with four children.
Vital signs:
BP:135/70 mmHg
Temp:98.5 F
RR:16/minute
HR:76/minute, regular
Protocol:
Knock three times with confidence, a smile, walk in and say:
Good morning, Ms Smith. I am Dr. Dora, and I am here to see you today as
your physician. Nice to meet you .Shake ha... 阅读全帖 |
|
g*2
发帖数: 658 | 47 Overview of running injuries of the lower extremity
Author
Lisa R Callahan, MD Section Editor
Karl B Fields, MD Deputy Editor
Jonathan Grayzel, MD, FAAEM
All topics are updated as new evidence becomes available and our peer review
process is complete.
Literature review current through: Feb 2012. | This topic last updated: Oct
20, 2011.
INTRODUCTION — Running is one of the world’s most popular forms of
exercise, with millions of regular participants. In the United States alone,
up to 40 mil... 阅读全帖 |
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H******7
发帖数: 34403 | 48 一百亿个安慰小段子，今天先发200个
1. No one can prepare you for a loss; it comes like a swift wind. But take
comfort in knowing that he/she is now resting in the arms of our Lord. Our/
My deepest condolences to you and your family.
2. When we lose a loved one here on earth, we gain an angel in heaven that
watches over us. May you take comfort in knowing that you have an angel to
watch over you now. We/I extend our/my most sincere condolences to you.
3. I/We am/are deeply saddened by the loss of your (insert re... 阅读全帖 |
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g*2
发帖数: 658 | 49 刚刚把堆积了几个星期的nejm翻看了一下，居然在11月底的那期case discussion就是
讲得这个病
http://www.nejm.org/doi/full/10.1056/NEJMcpc1103565
Case 36-2011 — A 93-Year-Old Woman with Shortness of Breath and Chest Pain
Presentation of Case
Dr. Pooja Agrawal (Emergency Medicine): A 93-year-old woman was seen in the
emergency department at this hospital because of chest pain and shortness of
breath.
The patient had been in her usual state of health, with hypertension and
chronic renal insufficiency, until the morning of admission, wh... 阅读全帖 |
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W*******n
发帖数: 4140 | 50 【The following file was given by me to some physicians, including Dr.
Robert S. April on my Nov. 08, 2019 visit. A very similar file was given to
a treating physician, Dr. Mehrdad Golzad. An earlier version was provided to
NYS Workers' Compensation Board and the WC insurance adjuster Ms. Lisa
White in June 2019. Almost nobody cares. Medical readers can understand why
the deniers want to wipe Neck off the established list of established injury
sites, because the Neck was seriously injured during ... 阅读全帖 |
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