Medical Flashcards
10 drugs that changed the world
Pharmacists will be aware of the heritage of many drugs used today and most will be familiar with the serendipitous discovery of penicillin. But some may be less acquainted with the role of happy chance in the unearthing of several other frequently used medicines.
In Ten Drugs: how plants, powders, and pills have shaped the history of medicine, science writer Thomas Hager provides a biography of ten common drugs that have had an important impact on modern medicine. The book simultaneously charts the rise of the pharmaceutical industry and considers how its careful advertising promoted benefits of the latest wonder drug, while muffling adverse effects.
The book begins with a chapter detailing humans’ long relationship with the poppy, which was once used for its euphoric constituent opium. Desire for the substance was insatiable and culminated in two opium wars between China and Britain in the mid-19th century. The chapter also describes how morphine was ultimately isolated from opium and became an effective painkiller in the 1800s, but also led to a plague of addiction.
The second chapter depicts the development of vaccination; as early as 1717, aristocrat Lady Mary Wortley Montagu, who lived in Constantinople (now Istanbul), recorded the practice of ‘engrafting’ — the prototype of inoculation — in which someone would scratch the skin of a child until it bled, and then place into the wound a small amount of smallpox scabs. This induced a mild form of the disease from which the child would recover.
A later chapter explains the origin of the term ‘a Mickey Finn’ — a drink that has been spiked with a drug — which emerged in 1915. It turns out that a saloon manager of the same name used chloral hydrate to sedate, and later rob, his semi-conscious customers. Chloral hydrate had been used to sedate mentally ill patients in the 1800s.
It was interesting to see that heroin was once used in over-the-counter cough mixtures and approved for general use by the American Medical Association in 1906. While in the 1930s, work with azo-dyes by chemists at Bayer led to the discovery of sulpha-like drugs, which were effective antibiotics.
Other breakthroughs include RP-4560 (chlorpromazine), an antihistamine that was shown to be valuable in sedating patients with mental health problems, and the fascinating development of the contraceptive pill in the 1950s. The book also covers more recent discoveries, including UK-94280, a drug originally developed to treat coronary heart disease, which had an unusual side effect in men; it was later named sildenafil and approved for medical use in 1998. Other opioid-like drugs, such as pethidine, methadone and fentanyl, are also described in some detail. Finally, separate chapters are devoted to statins and monoclonal antibodies — it is a travesty of justice that the two scientists who identified monoclonal antibodies in 1975 did not patent their discovery and, as a result, did not make any money from their work.
The book’s epilogue focuses on looking forward to potential innovations such as the polypill, which contains a combination of many medicines commonly used to treat heart disease; digital drugs, which send out signals once they have been consumed; and personalised medicine, based on an individual’s unique genome.
Hager finishes with a discussion of the problems facing the pharmaceutical industry. The rate of new innovations is ebbing, and sales are flattening; and in addition to persuading doctors to prescribe their drugs, the industry is lobbying an ever-widening group, including media personalities, lawyers and patient advocacy groups to improve sales.
Poison ivy treatment
•• Next up is Rachel; she’s 45 years old and spent yesterday golfing
with friends. Now she has two problems: sunburn on her shoulders
and face, and a very itchy rash on her legs. She says she’s a terrible
golfer, and spent a lot of time in the rough looking for her ball. She
figures she got poison ivy then.
•• Rachel is entirely correct. The sunburn is red, and the skin feels
warm, and there are blisters in places. Sunburn treatment is similar
to other burns: Try to prevent it, if you can, but once it’s there, get
out of the sun. Drink extra fluids, like you would after any burn;
take pain medications, and use soothing cool wet washcloths. Aloe
vera can help as well.
•• The poison ivy rash is shaped in streaks, from where the plant
touched her skin. Anyone with a poison ivy rash should clean up
the area well with soapy water, and wash their hands and clothes
and anything else that could have gotten poison ivy sap on it.
•• After cleaning, the rash can be treated with topical steroids—
usually, the potent prescription-strength kind. Often, oral or injected
steroids are given, too, in addition to oral antihistamines. The
allergic reaction that causes the rash of poison ivy is really quite
intense, and you sometimes need high doses of several medicines at
the same time to calm it down.
Diagnosing headaches
We are going to need more history and a physical exam. Headaches
are almost always diagnosable based only on the history, with
a physical exam to con rm suspicions. This is not a high-tech
diagnosis. It involves going through some crucial questions with
the patient to get an in-depth history.
The most crucial headache question is as follows: Is this your rst
headache or your worst headache? That’s very important—things
like an intracranial bleed will cause a severe, worst-in-your-life
headache, and that’s a huge red ag for immediate action.
More questions include the following: What happens when the
headache starts? What symptoms develop with the headache? With
migraines, there is often an aura—a visual or auditory phenomenon,
such as ashing lights, that precedes the headache.
Does the pain spread around? What does the pain feel like? Do you
have any other medical problems? Are you stuffy all the time or
just with the headaches? Is there anything that makes the headache
get worse or better? Are you taking any medicines? What happens
when you get a headache?
Migraines
The most common primary headache disorder is migraine. These
headaches last 4 to 72 hours and are unilateral (or at least begin
unilaterally). The pain is of moderate to severe intensity and has a
pulsating or throbbing quality. They get worse with activity, such as
walking around or working.
Migraines will always be accompanied by either nausea or vomiting
or a combination of photophobia and phonophobia—which means
that the headache gets worse with light and sound.
Though not part of the de nition of migraines, they characteristically
improve after sleep. Gordon mentioned sleeping off his headaches.
We’ve ruled out secondary headaches with our history and
physical, and his headache pattern ts perfectly into the de nition
of migraine. That’s our diagnosis.
Often, migraines are accompanied by changes in what’s called the
autonomic nervous system, the part of our nervous system that’s
automatic—the things we don’t have to think about. It includes
the nerves that make us sweat and the nerves that constrict blood
vessels and make the skin look pale.
Some migraine sufferers become pale and sweaty, and many feel
nausea or abdominal pain from these autonomic nerve changes.
Autonomic nerves also innervate the lining of the nose and
can cause nasal congestion or stuf ness from increased tissue
swelling—explaining why our patient thought he was having
sinus headaches.
Kims game.
Practice kims game and see what info you can remember.
Race, sex, age, height, weight colors, Dielect, Tattoos, Hair
Heat Exhaustion V Heat Stroke V Hyperthermia
Heat exhaustion and heat stroke are both serious conditions that can occur when the body is exposed to high temperatures and prolonged physical exertion. Here are the symptoms and treatments for each:
Heat Exhaustion:
Symptoms:
- Heavy sweating
- Fatigue and weakness
- Dizziness or lightheadedness
- Nausea or vomiting
- Headache
- Pale, cool, and moist skin
- Rapid heartbeat
- Muscle cramps
- Fainting or loss of consciousness (in severe cases)
Treatment:
- Move to a cool environment: Get out of the heat and into a shaded or air-conditioned area.
- Hydrate: Drink cool water or sports drinks to replace fluids and electrolytes lost through sweating.
- Rest: Lie down and elevate the legs to help improve blood flow to the heart and brain.
- Cool the body: Apply cool, wet cloths to the skin or take a cool shower.
- Loosen clothing: Remove or loosen tight or unnecessary clothing to allow heat to escape.
- Monitor symptoms: If symptoms worsen or do not improve within 30 minutes, seek medical attention.
Heat Stroke:
Symptoms:
- High body temperature (above 103°F or 39.4°C)
- Altered mental state or confusion
- Rapid and shallow breathing
- Rapid heartbeat
- Flushed, hot, and dry skin (lack of sweating)
- Headache
- Nausea or vomiting
- Fainting or loss of consciousness
- Seizures (in severe cases)
Treatment:
- Call emergency services: Heat stroke is a medical emergency that requires immediate medical attention.
- Move to a cool place: Get the person out of the heat and into a shaded or air-conditioned area.
- Cool the body rapidly: Immerse the person in a cool bath or shower, or use cool water spray and fan the person to promote cooling.
- Monitor vital signs: Check the person’s temperature and monitor their breathing and heart rate until medical help arrives.
It’s important to note that heat stroke is a life-threatening condition, and delaying medical treatment can have severe consequences. If you suspect someone is experiencing heat stroke, it is crucial to seek emergency medical help immediately.
Hyperthermia is a condition characterized by an elevated body temperature that is above the normal range due to external factors, such as exposure to hot environments or strenuous physical activity. It can encompass both heat exhaustion and heat stroke. Here’s some additional information on hyperthermia:
Hyperthermia:
Hyperthermia refers to an elevated body temperature that is not necessarily caused by an infection but rather by external factors. It can be broadly categorized into two types:
Heat Exhaustion: Heat exhaustion is a form of hyperthermia and is considered a milder condition than heat stroke. The symptoms and treatment for heat exhaustion are described in the previous response.
Heat Stroke: Heat stroke is the most severe form of hyperthermia and is a medical emergency. It occurs when the body’s internal temperature regulation system fails, leading to a dangerously high body temperature. Symptoms and treatment for heat stroke are also described in the previous response.
Treatment for hyperthermia, regardless of the specific type, involves immediate actions to lower the body temperature and prevent further complications. These measures include:
Moving to a cool environment: Get out of the heat and into a shaded or air-conditioned area.
Cooling the body: Apply cool water to the skin, use fans or air conditioning, or apply ice packs to areas with a rich blood supply, such as the armpits and groin.
Hydrating: Drink cool water or sports drinks to replace fluids and electrolytes lost through sweating.
Resting: Lie down and elevate the legs to improve blood flow to the heart and brain.
Seeking medical attention: If symptoms worsen, do not improve within 30 minutes, or if there are signs of heat stroke, seek immediate medical help.
Ear Infections
To treat an ear infection:
- Use over-the-counter pain relievers for pain relief.
- Apply a warm compress to the affected ear.
- Keep the ear dry during bathing or swimming.
- Use prescribed antibiotic ear drops if recommended.
- Take prescribed oral antibiotics and complete the full course.
- Follow up with your healthcare provider if symptoms persist or worsen.
- Seek immediate medical attention for severe symptoms or complications.
Note: Consult a healthcare professional for personalized advice and treatment based on your specific condition.
How to lose a tail.
Use them - Put receipt in trash can. Hand a news paper to a stranger.
Abuse them - Waste their day. Stay in book stores way too long.
Lose them - Use elevators. Go to places in other entrances.
Hay Fever
Hay fever, also known as allergic rhinitis, is an allergic reaction to airborne substances such as pollen, dust mites, pet dander, or mold spores. It commonly occurs during specific seasons when certain allergens are prevalent. Here are the symptoms and treatment options for hay fever:
Symptoms of Hay Fever:
- Sneezing
- Runny or stuffy nose
- Itchy or watery eyes
- Itchy throat or ears
- Coughing
- Fatigue
- Mild headache
- Postnasal drip (mucus draining down the throat)
Treatment for Hay Fever:
- Avoid allergens: Minimize exposure to allergens that trigger your symptoms. Stay indoors when pollen counts are high, use air purifiers with HEPA filters, keep windows closed, and avoid outdoor activities during peak pollen times.
- Use nasal saline rinses: Regularly rinsing your nasal passages with a saline solution can help flush out allergens and reduce congestion. This can be done using a neti pot, squeeze bottle, or nasal irrigation device.
- Over-the-counter medications:
- Antihistamines: These medications block the effects of histamine, a chemical released during an allergic reaction. They can help relieve sneezing, itching, and runny nose. Examples include cetirizine, loratadine, and fexofenadine.
- Decongestants: These medications help reduce nasal congestion by narrowing blood vessels. They are available in oral or nasal spray forms. Note that nasal decongestant sprays should not be used for more than a few days, as they can cause rebound congestion.
- Nasal corticosteroids: These nasal sprays help reduce inflammation and relieve nasal symptoms. They can take a few days to reach full effectiveness. Examples include fluticasone, budesonide, and mometasone.
- Eye drops: Over-the-counter antihistamine eye drops can help relieve itchy, red, and watery eyes. Avoid rubbing your eyes, as it can worsen symptoms.
- Allergy shots (Immunotherapy): If hay fever symptoms are severe or not well-controlled with medications, your healthcare provider may recommend allergy shots. These shots expose you to gradually increasing amounts of allergens over time, which can help desensitize your immune system and reduce symptoms.
- Allergy-proof your home: Take steps to minimize exposure to allergens indoors. Use dust mite-proof covers on bedding, vacuum regularly with a HEPA-filtered vacuum cleaner, and keep indoor humidity levels low to prevent mold growth.
- Consult a healthcare professional: If your symptoms are persistent, severe, or significantly affecting your quality of life, it’s advisable to consult a healthcare professional. They can assess your condition, provide a proper diagnosis, and recommend appropriate treatment options.
Remember, the effectiveness of treatment may vary for each individual, and it may take some trial and error to find the right combination of therapies that work best for you. It’s also important to start treatment before the onset of symptoms or allergy season for better symptom control.
Treating Scorpion Stings
If you or someone else has been stung by a scorpion, it’s important to take the following steps for treatment:
Localized pain: The site of the sting may be painful, ranging from mild to severe, and can persist for several hours or even days.
Swelling and redness: The sting area may become swollen, red, and inflamed.
Numbness or tingling: Some individuals may experience numbness or tingling around the sting site or in the surrounding area.
Paresthesia: Unusual sensations like pins and needles or a “tingling” feeling may be felt in other parts of the body.
Muscle spasms: In some cases, muscle spasms or cramping can occur, especially in the area near the sting.
Sweating and increased heart rate: The person stung may experience increased sweating and a faster heart rate.
Restlessness or agitation: Restlessness, anxiety, or a feeling of restlessness can sometimes occur.
Systemic symptoms: Severe reactions to scorpion stings are rare, but in some cases, more serious symptoms can develop, such as difficulty breathing, chest pain, high blood pressure, or rapid heartbeat. These symptoms may indicate a severe allergic reaction and require immediate medical attention.
- Stay calm: Although a scorpion sting can be painful, try to remain calm to help slow the spread of venom.
- Remove the stinger (if present): Some scorpions may have a stinger that remains in the skin after a sting. If visible, carefully remove the stinger using tweezers or the edge of a credit card. Be cautious not to squeeze the venom sac attached to the stinger, as it can release more venom.
- Clean the area: Wash the sting site gently with mild soap and water to reduce the risk of infection. Pat it dry with a clean cloth.
- Apply a cold compress: Place a cold compress or ice pack wrapped in a thin cloth on the sting area for about 10-15 minutes. This can help reduce swelling and provide temporary relief from pain.
- Manage pain and discomfort: Over-the-counter pain relievers, such as acetaminophen or ibuprofen, can help alleviate pain and reduce swelling. Follow the recommended dosage instructions.
- Monitor for severe symptoms: While most scorpion stings cause only localized pain and swelling, some individuals may experience more severe symptoms. Watch for signs of an allergic reaction, such as difficulty breathing, chest tightness, or swelling of the face, lips, or throat. If these symptoms occur, seek immediate medical attention.
- Seek medical attention: It is recommended to seek medical attention for scorpion stings, especially if the following apply:
- The sting was from a potentially dangerous scorpion species.
- Severe pain, swelling, or other systemic symptoms are present.
- The person stung is a child, elderly, or has pre-existing health conditions.
It’s important to note that specific treatment for scorpion stings may vary based on the species of scorpion and the severity of symptoms. Medical professionals can provide appropriate evaluation, manage complications, and administer antivenom if necessary.
Prevention is key to avoid scorpion stings. Take precautions such as wearing protective clothing, shaking out shoes and clothing before wearing them, and keeping living areas clean and free of scorpions.
Major Depression
It’s important to make the distinction between depression—that is, the common word meaning “sadness”—and depression, the pervasive emotional disorder with speci c symptoms that span far outside the realm of sadness. Of course, we all experience sadness
related to life’s disappointments, bereavement, and ordinary turmoil.
When we speak of depression as a diagnosis, we’re referring to
something not only more intense in quality, but also broader in its
effect on lives and families. Sometimes, the medical diagnosis is
referred to as “major depression” to underscore this difference.
The rst primary symptom of depression is depressed mood. This can be something reported by the patient—for example, “I feel sad a lot”—or something noticed by the family. In teenagers, a depressed mood can come across as more of an irritable mood, with
frequent ghting and outbursts. To qualify as major depression,
the depressed mood occurs most of the day, nearly every day. Our
patient was at times sad and at times quite irritable.
The second main symptom is a lack of interest in pleasurable
activities. In teenagers, this often presents as social withdrawal,
dropping out of activities, or spending very little time with friends or hobbies that used to be enjoyable. One or the other, or both, of
these two main symptoms of withdrawal and depressed mood are
always present in major depression. Our patient had both.
There are also a number of other symptoms, and for a formal
diagnosis, at least four of these must be present to con rm the
diagnosis of depression.
So-called vegetative symptoms affect our basic life functions. There
can be signi cant changes in appetite leading to either weight loss
or weight gain. Depression can also affect sleep cycles, leading to
either reduced or increased sleep. Even when there is a lot of sleep,
fatigue or loss of energy is reported.
There are also qualitative and quantitative changes in thinking
patterns. Many patients with depression experience cognitive
slowing, or a lack of ability to think or focus. Thoughts that do
occur are often preoccupied with feelings of guilt or worthlessness
that may even border on delusional—sometimes patients blame
themselves for many things that are clearly not their fault. There can
be pervasive hopelessness and recurrent thoughts of death, which
may include thinking about suicide or planning or performing a
suicidal act.
Although the symptoms of depression in children and adults
are similar in many ways, there are some signi cant differences.
Teenagers are as likely to present with irritability, anger, or
abusive language as with sadness. They more often have somatic
complaints, such as bellyaches, headaches, nausea, or dizziness. In
fact, chronic unexplained pain should always raise the suspicion of
depression as a possible diagnosis.
Depressed teens often complain of being bored and have low energy.
They may become extremely sensitive to perceived rejection or lack
of success. School absences and/or decreasing school performance
are nearly universal ndings in childhood depression.
Depression is a serious problem. About four to eight percent of adolescents experience a major depressive episode each year,
leading to substantial problems at school and at home. Depressed teens may fail in school, lose their jobs, or turn to drugs of abuse. In addition, depression contributes to most cases of suicide, which
is now the number one killer of young adults in the United States.
There are clearly both environmental and genetic factors that
contribute to the development of depression. Risk factors for
children can include a history of neglect, abuse, loss of a parent
(especially the same-sex parent), psychosocial deprivation, or
chronic illness. However, although these factors increase the risk of
depression, most children with, for example, chronic illness do not
become depressed.
In addition, whether stresses are accompanied by a supportive
family may in uence the possible development of depression.Familial or genetic factors also play a role in how resilient people
can be to life’s stress.
There are several ways to treat adolescent depression. Certainly,
helping to create a supportive home and school environment is
essential, as is trying to gradually get the patient involved again
with pleasurable activities and exercise. Sleep habits and daily
routines may need to be normalized.
Any coexisting anxiety or other mental problems, substance abuse,
learning problems, or medical issues need to be evaluated and
addressed, even while pursuing active therapy for depression.
Psychotherapy can be effective, especially for mild-to-moderate
depression. The most well-studied form of therapy is called
cognitive behavioral therapy, which at its core is an application of
the idea that our thoughts cause our feelings and behaviors.
Although talking is of course involved, cognitive behavioral
therapy isn’t just talking about feelings—it’s a focused approach to
help patients learn to recognize their own thoughts, learn how they
lead to distressing symptoms, and most importantly, how to change
the way they think about things. Psychotherapy isn’t as effective
for more severely affected patients and may take weeks or months
to help.
The other effective therapeutic option is antidepressant medications.
These aren’t in any way “happy pills.” They do not work quickly,
but over the span of weeks, these medications can help with the
mood and physical symptoms of depression.
The most widely used group of these medications are called SSRIs.
Overall, SSRIs are quite safe and well tolerated. However, some
studies have showed an increase in suicidal thoughts (though not
actions) in the rst weeks of therapy, leading to an FDA warning
on the label concerning the suicide risk. Ironically, the drop in SSRI
usage caused by concerns raised by this warning has led to a net increase in teen suicide, probably because fewer teens could get
effective therapy.
How to treat blisters
To treat a blister, you can follow these steps:
- Leave it intact: If the blister is small, unbroken, and not causing significant discomfort, it’s generally best to leave it intact. The blister acts as a natural protective barrier against infection.
- Clean the area: If the blister has popped or is at risk of popping due to friction or pressure, clean the area with mild soap and water to reduce the risk of infection. Gently pat the area dry with a clean towel.
- Apply a protective covering: Use a sterile adhesive bandage or a moleskin pad to protect the blistered area from further friction or irritation. Ensure that the covering is larger than the blister to provide adequate protection.
- Relieve discomfort: If the blister is causing pain or discomfort, you can take over-the-counter pain relievers like acetaminophen or ibuprofen, following the recommended dosage instructions.
- Avoid draining unless necessary: Avoid intentionally draining the blister unless it is large, painful, or likely to burst on its own. If drainage becomes necessary, clean a needle or pin with rubbing alcohol, then gently puncture the edge of the blister, allowing the fluid to drain. Leave the overlying skin intact to serve as a natural bandage.
- Keep it clean and dry: Keep the blister clean and dry to promote healing. Change the protective covering daily or whenever it becomes dirty or wet.
- Monitor for infection: Keep an eye out for signs of infection, such as increased pain, redness, warmth, swelling, or pus. If signs of infection develop, seek medical attention promptly.
It’s important to note that if you have diabetes, poor circulation, a compromised immune system, or the blister is extensive or located in a sensitive area, it’s best to seek medical advice for proper evaluation and treatment.
Folk cures for allergies
While natural remedies may not be as extensively studied as conventional medical treatments, some people find them helpful in managing allergy symptoms. Here are a few natural remedies that some individuals have reported to be beneficial:
- Nasal rinses with saline solution: Using a saline rinse, such as a neti pot or nasal irrigation device, can help flush out allergens from the nasal passages and reduce congestion. It can be effective in relieving nasal symptoms.
- Quercetin: Quercetin is a plant pigment with antioxidant and anti-inflammatory properties. It is found naturally in foods like onions, apples, berries, and leafy greens. Some studies suggest that quercetin may help reduce allergy symptoms by stabilizing mast cells, which release histamine during an allergic reaction. However, more research is needed to establish its effectiveness.
- Butterbur: Butterbur is a herb that has been used traditionally for various conditions, including allergies. It may have antihistamine and anti-inflammatory effects. However, it’s important to note that raw butterbur contains compounds that can be toxic to the liver, so it should only be used in a processed form that removes these compounds.
- Probiotics: Probiotics are beneficial bacteria that can support gut health and immune function. Some studies suggest that certain strains of probiotics may help modulate the immune response and reduce allergy symptoms. However, more research is needed to determine the specific strains and dosages that are effective.
- Local honey: Some people believe that consuming local honey, which contains trace amounts of local pollen, can help build tolerance to allergens and reduce symptoms. However, scientific evidence supporting this claim is limited.
It’s important to note that natural remedies may not work for everyone, and their effectiveness may vary. Additionally, it’s crucial to consult with a healthcare professional before trying any natural remedies, especially if you have underlying medical conditions or are taking medications, to ensure they are safe and appropriate for you.
Remember, if your allergy symptoms are severe or significantly impacting your quality of life, it’s advisable to seek medical advice from a healthcare professional for proper diagnosis and treatment options.
Ringworm / Athletes food
Ringworm, also known as dermatophytosis, is a fungal infection of the skin that can affect various parts of the body, including the scalp, body, feet (athlete’s foot), and groin (jock itch). The symptoms and treatments of ringworm can vary depending on the location of the infection:
- Scalp Ringworm (Tinea Capitis):
- Symptoms: Itchy, red, scaly patches on the scalp, hair loss, small black dots (broken hair shafts), swollen lymph nodes.
- Treatment: Antifungal medications taken orally (such as griseofulvin, terbinafine, or itraconazole) are typically prescribed for several weeks. Antifungal shampoos or topical creams may also be recommended. - Body Ringworm (Tinea Corporis):
- Symptoms: Red, circular or ring-shaped patches with a raised, scaly border. The patches may be itchy or cause a burning sensation.
- Treatment: Topical antifungal creams or lotions (such as clotrimazole, miconazole, or terbinafine) are commonly used for 2 to 4 weeks. Keeping the affected area clean and dry is important. - Feet Ringworm (Athlete’s Foot or Tinea Pedis):
- Symptoms: Itchy, peeling skin between the toes, redness, blistering, cracking skin, and a stinging or burning sensation.
- Treatment: Over-the-counter antifungal creams or sprays containing ingredients like clotrimazole, miconazole, or terbinafine are usually effective. Good foot hygiene, including keeping the feet clean and dry, wearing clean socks and shoes, and avoiding walking barefoot in public areas, is essential. - Groin Ringworm (Jock Itch or Tinea Cruris):
- Symptoms: Itchy, red, scaly rash in the groin area, inner thighs, buttocks, or genitals. The rash may have raised edges and central clearing.
- Treatment: Topical antifungal creams or powders (such as clotrimazole, miconazole, or terbinafine) are typically applied twice daily for several weeks. Keeping the area clean and dry is important.
In addition to the specific treatments mentioned above, general measures for managing ringworm include:
- Good hygiene: Keep the affected area clean and dry. Wash and dry towels, clothing, and bedding regularly.
- Avoid sharing personal items: Do not share towels, clothing, combs, or other personal items with someone who has ringworm.
- Prevention: Practice good hygiene, keep the skin dry, wear clean clothes, and avoid walking barefoot in public areas.
It’s important to note that while over-the-counter treatments may be sufficient for mild cases of ringworm, more severe or persistent infections may require prescription-strength antifungal medications. If you suspect you have ringworm or if the symptoms worsen or do not improve with treatment, it is advisable to consult a healthcare professional for a proper diagnosis and appropriate treatment plan.
Night movement
Move extremely slow at night,
Camo up
Stay in the shadows
Move from concealment to concealment.
Beware the third dimension of the city. They can see you from the top of buildings.
Mother and son vomiting
•• Today we start with two patients together, a mother and her
20-month-old son. Typically, we don’t see two patients at the
same time in the ED, to protect privacy and to make sure we do a
complete job, but in this case it doesn’t make any sense to separate
them. The mom is Kayla; she’s 20 years old. We’ll call her son
Junior. They’re here with a chief complaint of “vomiting.”
•• Kayla says that this started in December, three weeks ago. She
noticed she was having headaches, but thought it was because she
was working hard around the holidays. Some days she’d wake up
feeling sick and she’d throw up. But she had to go to work so she
would take Junior to his grandmother’s or day care. Usually, once at
work, she would feel OK.
•• Kayla says they had moved into their own place, but that was in
November. She has a new job, and Junior had started going to day
care three days a week—the other days he stays with his grandmother.
Perhaps he’s catching something from the other kids in day care?
•• At about the same time Kayla got sick, Junior started having
occasional vomiting, too. Not frequently, but a few times a week,
usually in the mornings. Once he was at his grandmother’s, he would usually feel better. You do your physical exams, and find that
both patients seem well.
•• You’ve got an explanation: Ever since Junior started day care he’s
been catching viral infections and bringing them home to Kayla.
Does it all fit? Healthy paranoia says to keep digging.
•• You ask Kayla whether they seem to catch the vomiting from each
other. She says yes, but the grandmother never seems to catch it.
Neither Kayla nor Junior has had fevers or diarrhea—two symptoms
of viral infections. That absence points away from a virus.
•• Still, what else could it be? Maybe it’s just a coincidence. You’re
not sure, yet. Let’s see another patient while Kayla and her son are
observed for a further interval in the ED.
•• They look fine. Junior (who had been kind of sleepy earlier) is now
running around the room, and Kayla, again, says she feels better.
You say, “I just want to make sure I’m not missing anything. When,
exactly, did this start?”
•• Kayla says the symptoms started two weeks after they moved into
their new apartment. Kayla looks embarrassed—it sounds like her
apartment is a basement of a building, but again, she says it’s all she
can afford.
•• What’s in the apartment that’s making them both sick? You only
need one test, and you ask the nurse to draw it on both the mom
and the child. It’s a carboxyhemoglobin level, which detects carbon
monoxide. And you find that both mom and Junior have elevated
carboxyhemoglobins. Both of them, since the weather got colder
and the furnaces in their basement apartment have been running,
have been exposed to carbon monoxide.
•• The most important step is to make sure they don’t go back to
their apartment, and to call the health department to investigate the
building. Kayla and Junior, you tell them, should go back to live
with Junior’s grandmother, at least for a little while.
•• Though they weren’t badly ill now, it was a matter of time—if
one night was even colder, the furnaces could have made enough
carbon monoxide to kill Kayla and her son. Getting the diagnosis
Broken wrist or something worse?
•• The X-ray of Tonya’s wrist is complete, and her mom is here with
her now. On Tonya’s X-ray you see a broken bone at the end of
the wrist. You head into Tonya’s room to talk with her family, and
something isn’t right. Tonya is lying down, and she looks pale and
sweaty. Her mother says, “Is it broken? She looks really bad.”
•• You try to shake her awake, and she doesn’t respond. You call for a
nurse to help out, and start your ABCs. Airway: Tonya’s airway is
open. Breathing: You can see her chest rising and falling. Circulation:
You feel a pulse, and it’s fast and does not feel especially strong.
•• The clinical scenario that’s most likely here is shock, which means
that there’s not enough blood and oxygen getting to where it needs
to go, leading to cellular injury and organ dysfunction. Her heart rate
has sped up in an effort to get more blood around, but it’s not enough.
•• The nurse has already started work on getting an IV in place, and
another splints her wrist to prevent further injury. You also put
Tonya on oxygen, and tell the nurse what fluids to run into the IV
once it’s started. Tonya’s mom is escorted to the hall.
•• With Tonya, our top concern is that she’s in shock related to trauma,
from the fall off of the bike. Internal bleeding in her abdomen or in
her skull could cause her symptoms. A quick bedside test is done.
There’s no free fluid, meaning it’s unlikely that there’s bleeding in
the abdomen. Her exam is fairly normal.
•• Tonya’s vitals look a little better since the fluid started running in,
and she’s coming around and talking more. You’ve decided she
doesn’t need mechanical ventilation, though you’ll certainly keep
an eye on her ABCs.
•• The next step is to arrange for a head CT scan to look for bleeding
in the brain. But before she’s rolled over to radiology, you repeat the
exam. On her upper chest is a new cluster of reddish-purple marks,
kind of like bruises. You press the skin, and the discoloration does
not fade away with pressure.
•• These marks are called petechiae—they’re small broken blood
vessels under the skin, or small areas where blood has leaked out of
the vessels. When a bunch of petechiae cluster together, it’s called
purpura. Whatever it’s called, it’s not good.
•• You order IV antibiotics—overwhelming infection is one cause of
purpura, and that would explain shock, too. You notify the blood
bank that your patient may need transfusions of blood or platelets,
and you arrange admission to the intensive care unit upstairs.
•• Within a few hours, Tonya becomes completely unresponsive. She
requires intense medical support, and develops other signs of organ
dysfunction. Testing confirms that Tonya was septic, with bacteria
growing in her blood. Hopefully, she’ll pull through this, but it’s
going to be a battle for her.
•• Tonya came in with a hurt wrist; when she became very ill, the
logical thought was that the fall that broke her wrist also caused
internal injuries. But, in fact, the cause of her significant illness
was sepsis. Treat the cause, not the symptoms—though sometimes
that’s easier said than done.
Suggested
Healing Fractures
Setting and healing a fracture should be done under the supervision of a healthcare professional. However, here are some general steps involved in the process:
- Medical evaluation: Seek immediate medical attention for a suspected fracture. A healthcare professional will examine the injury, potentially using X-rays or other imaging tests to confirm the fracture and determine its severity.
- Immobilization: The injured area needs to be immobilized to prevent further damage and promote healing. This may involve the use of splints, casts, braces, or traction, depending on the type and location of the fracture. The healthcare professional will determine the appropriate immobilization method.
- Reduction: If the fracture is displaced or unstable, a reduction may be necessary to realign the bones. There are two types of reduction:a. Closed reduction: The bones are manipulated and realigned without surgical intervention. This is typically done under anesthesia or with the use of pain medication.b. Open reduction: In more complex fractures, surgery may be required. The surgeon will make an incision to access the fracture site and realign the bones using screws, plates, or other fixation devices.
- Pain management: Pain medication may be prescribed or recommended to manage pain during the healing process.
- Follow-up care: Regular follow-up appointments with the healthcare professional are essential to monitor the healing progress, ensure proper alignment, and make any necessary adjustments to the treatment plan.
- Rehabilitation: Once the initial healing phase has passed, rehabilitation exercises and physical therapy may be recommended to restore strength, range of motion, and function to the affected area.
It’s crucial to emphasize that setting and healing a fracture should be done by a qualified healthcare professional. They have the expertise and tools to ensure proper alignment, minimize complications, and promote optimal healing.
Obesity
The treatment of obesity hypoventilation syndrome starts with weight loss. This is not easy to do, and often patients are not
successful in losing weight. However, if weight can be lost,
sometimes even a small percentage, there can be a big improvement
in sleep quality and ventilation.
For a patient like Joe, who is already in heart failure, weight loss
is still a goal, but more aggressive therapy would be started right
away. This would include ventilatory assistance during sleep, using
a mask device that can provide positive pressure—a sort of push on the air to keep the airway open and make sure that there is airflow both in and out. The device also makes sure that enough breaths are
taken each minute to ensure adequate ventilation.
Joe also needs treatment for his heart failure. This may include
diuretic medications to increase urine output and decrease retained fluid; it may also include medicines to get the heart to pump harder
or more ef ciently, plus medication to control Joe’s blood pressure.
If treatment of his obesity hypoventilation syndrome itself is
successful, his heart can recover, and he may not continue to need
these heart medicines, but for now, there isn’t time to wait and see.
The most aggressive therapy to help patients like Joe lose weight
is bariatric surgery, which includes methods like stomach stapling or intestinal bypass to decrease the amount of food he can eat or
decrease the number of calories that he can absorb.
In Joe’s condition, with heart failure, this kind of surgery is too
risky, but perhaps with some improvement he may be able to
tolerate a bariatric procedure. Improvements in bariatric techniques
are making the surgery less risky, but they’re still not suitable for
patients like Joe.
Obesity can lead to heart failure. Obesity also contributes to
orthopedic problems like bad knees and hips, high blood pressure,
coronary artery disease, some cancers, cholesterol disorders, stroke,
liver and gallbladder disease, etc.
Insect Bite
Rachel’s Boil
•• Let’s meet Rachel. She’s 28, and her chief complaint is “spider
bite.” She has a warm, raised, pink area on her forearm, with a
small central area that looks white or yellowish. She says it hurts
a little, but that otherwise she feels OK. She thinks she got bitten a
few days ago.
•• Only two spider species cause problematic bites in the U.S. The black
widow spider’s initial bite is usually painless, but if a significant
amount of venom was transferred with the bite, a few hours later
there can be painful muscle cramps or twitching, then rarely trouble
breathing and other systemic symptoms. In contrast, the brown
recluse spider can cause a severe local reaction at the site of its bite,
including an open ulcer with dying tissue 5–7 days after a bite. Very
rarely, there can be systemic reactions to the venom, but for the most
part the concern after a brown recluse bite is local wound care.
•• Does it sound like Rachel has a spider bite? It’s certainly not a
black widow bite, and it’s almost certainly not a brown recluse
spider bite, either. In fact, what Rachel has is called a furuncle,or more commonly a
boil. This is an acute,
tender superficial skin
infection that’s almost
always caused by the
bacteria Staphylococcus
aureus.
•• Using a warm wet
compress can help, and
if there’s a pocket of
pus there we’d typically
open up the boil to let
it drain. Sometimes a
topical or oral antibiotic
effective against staph
can help, though the
most important step is
draining the abscess.
•• Rachel is reassured
to learn that it’s not a
spider bite, but she’s
still worried—what if
it’s a tick bite? Certain
ticks can carry Lyme
disease (rash, ongoing
complications if untreated) or Rocky Mountain spotted fever
(headache, fever, rash, vomiting, abdominal pain, other problems).
Both are potentially severe if untreated, but both can be treated with
antibiotics.
•• But you tell Rachel that this doesn’t look like a tick bite. If more
symptoms begin, she ought to come back here or go see her own
doctor, but for now all she needs is local wound care. You tell her
to use warm soaks and a topical antibiotic cream, and you send
her home.
Treating Diarrhea
Mild Diarrhea:
Symptoms: Mild diarrhea is typically characterized by loose or watery stools, occurring a few times a day.
Duration: It usually lasts for a short duration, commonly a few days.
General well-being: Despite experiencing diarrhea, individuals with mild cases generally maintain normal hydration and are able to go about their daily activities.
Treatment:
Hydration: Focus on maintaining fluid intake to prevent dehydration. Drinking water, clear broths, oral rehydration solutions (ORS), or electrolyte-rich drinks can be helpful.
Diet: Gradually reintroduce bland, easy-to-digest foods such as rice, bananas, toast, and boiled potatoes. Avoid spicy, fatty, or greasy foods, caffeine, and alcohol.
Symptom relief: Over-the-counter anti-diarrheal medications, such as loperamide (Imodium), may help alleviate symptoms. However, these medications should be used with caution and only as directed.
Serious Diarrhea:
Symptoms: Serious diarrhea often involves frequent, persistent, or severe watery stools that may contain blood or mucus. Other symptoms can include abdominal pain, cramps, fever, and dehydration.
Phases of societal Crash
Phase 1: Cooperation: 24 hours.
People will work together and are willing to share
Phase 2: Self Preservation: 48 hours.
People will think more of preserving food and water.
Phase 3: Anarchy: 2 weeks.
Cops home and take of their families. 600 people died in this stage of katrina.
Phase 4-5: Tribalism/Warlords.
Indeterminate
How to treat burns
The treatment for different types of burns can vary. Here are some general guidelines for treating different degrees of burns:
- First-degree burns (Superficial burns):
- These burns affect the outermost layer of the skin (epidermis).
- Remove the source of heat and run cool (not cold) water over the burn for about 10-20 minutes to help alleviate pain and reduce heat.
- Do not use ice or icy water as it may further damage the skin.
- Gently pat the burn dry with a clean, sterile cloth.
- Apply a soothing burn ointment or aloe vera gel to the burn to promote healing and relieve discomfort.
- Cover the burn with a sterile non-stick dressing or a clean cloth to protect it. - Second-degree burns (Partial-thickness burns):
- These burns affect the epidermis and extend into the second layer of skin (dermis).
- For superficial second-degree burns, follow the same steps as first-degree burns.
- For deeper second-degree burns, seek medical attention as they may require professional care, such as cleaning, dressing changes, and potential use of antibiotics or specialized burn treatments. - Third-degree burns (Full-thickness burns):
- These burns extend through all layers of the skin and may involve underlying tissues.
- Third-degree burns require immediate medical attention. Call emergency services or go to the nearest emergency room.
- While waiting for medical help, do not remove any clothing stuck to the burn.
- Cover the burn with a clean, dry cloth or sterile dressing to protect it.
- Keep the affected person lying down and elevate the burned area, if possible.
- Do not apply any creams, ointments, or home remedies to third-degree burns, as they can interfere with medical treatment.
Remember, these are general guidelines, and it’s important to seek medical attention for severe burns, burns on sensitive areas (face, hands, feet, genitals), burns caused by chemicals or electricity, or burns in individuals with pre-existing health conditions. Proper medical evaluation and treatment are crucial to promote healing, prevent infection, and minimize scarring.
Kidney Stones
Kidney stones are hard deposits that form in the kidneys. They can cause significant pain and discomfort when they obstruct the urinary tract. Here are the symptoms and treatments for kidney stones:
Symptoms:
1. Severe pain in the side or back, below the ribs.
2. Pain that radiates to the lower abdomen and groin.
3. Hematuria (blood in urine).
4. Cloudy or foul-smelling urine.
5. Frequent urination.
6. Urgency to urinate.
7. Painful urination.
8. Nausea and vomiting.
9. Fever and chills (if there is an accompanying infection).
Treatment:
1. Pain management: Over-the-counter pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, can help alleviate the pain associated with kidney stones. In some cases, stronger prescription pain medications may be needed.
2. Hydration: Drinking plenty of fluids, especially water, can help flush out the kidney stones and prevent new ones from forming. Adequate hydration is crucial in the treatment and prevention of kidney stones.
3. Medications:
- Alpha-blockers: These medications help relax the muscles in the urinary tract, facilitating the passage of kidney stones.
- Medications to control underlying conditions: Depending on the composition and underlying causes of kidney stones, specific medications may be prescribed to manage conditions such as hyperparathyroidism or gout.
4. Medical procedures:
- Extracorporeal Shock Wave Lithotripsy (ESWL): This procedure uses shock waves to break the kidney stones into smaller pieces, making it easier for them to pass through the urinary tract.
- Ureteroscopy: A thin tube is inserted into the urinary tract to remove or break up larger stones.
- Percutaneous Nephrolithotomy (PCNL): In cases of larger or more complex stones, a surgical procedure may be performed to remove or break up the stones using a small incision and specialized instruments.
5. Surgery: In rare cases where other treatments are not effective, open surgery may be necessary to remove the kidney stones.
Prevention:
1. Hydration: Drinking plenty of water and maintaining adequate fluid intake can help prevent the formation of kidney stones.
2. Dietary modifications: Depending on the type of kidney stones, specific dietary changes may be recommended to reduce the risk of stone formation. This may include reducing sodium and animal protein intake and avoiding high-oxalate foods.
3. Medications: In some cases, medications may be prescribed to prevent the formation of specific types of kidney stones.
It is important to consult with a healthcare provider for proper diagnosis, treatment, and prevention strategies tailored to individual circumstances.
when are amputations performed
Amputations are performed as a last resort when other treatment options have been exhausted or when the limb or body part is severely damaged or diseased beyond repair. The most common reasons for amputations include:
- Traumatic injury: Severe accidents or injuries that result in extensive damage to the limb, such as crush injuries, severe burns, or avulsion injuries, may require amputation.
- Peripheral vascular disease: In cases where there is a significant blockage of blood vessels in the limbs (peripheral artery disease) or severe infections, amputation may be necessary to prevent further complications or to save the person’s life.
- Cancerous tumors: Malignant tumors that affect the bones, muscles, or soft tissues of the limb may require amputation to remove the cancer and prevent its spread to other parts of the body.
- Severe infections: Infections that do not respond to antibiotics or other treatments and pose a risk to the person’s overall health may necessitate amputation to control the infection.
Its done Where the extremity looses pulse, temperature, its no longer sensitive to the touch, Its very red or black and when a bone had been crushed beyond repair
The process of amputation typically involves the following steps:
- Evaluation and planning: A team of healthcare professionals, including surgeons and rehabilitation specialists, will assess the individual’s condition, evaluate the extent of the injury or disease, and develop a personalized treatment plan.
- Anesthesia: Before the surgery, the person will receive anesthesia to ensure they are comfortable and pain-free during the procedure. The type of anesthesia used may vary based on the specific circumstances and the individual’s overall health.
- Surgical procedure: The surgeon will remove the damaged or diseased part of the limb, taking care to preserve as much healthy tissue as possible. Surgical techniques and the level of amputation will depend on the specific circumstances.
- Wound closure and healing: After the amputation, the surgical site is closed using sutures or other closure methods. The wound is then carefully monitored and managed to promote healing and prevent infection.
- Rehabilitation and prosthetics: Following the amputation, the individual will undergo rehabilitation to help regain strength, mobility, and independence. This may involve physical therapy, occupational therapy, and the fitting and use of prosthetic devices or assistive devices to aid in daily activities.
It’s important to note that amputations are complex procedures with long-term physical and psychological implications. The decision to perform an amputation is made after careful consideration of all available treatment options, weighing the risks and benefits, and with the active involvement of the individual and their healthcare team.
Treating Burns
For burns, first aid begins with stopping the burning process by
removing clothes and jewelry. Then, burns should be cooled by
irrigating them with room-temperature water. This reduces cellular
damage by limiting the depth and width of burns. Ice is not a good
idea—it freezes tissue, and can actually increase tissue damage.
Surviving a fire
Surviving a fire requires quick thinking, preparedness, and decisive action. Here are some essential steps to increase your chances of survival in a fire emergency:
- Stay calm and alert: Panic can impair your ability to make clear decisions. Stay as calm as possible and focus on taking appropriate actions.
- Alert others: If there are other people in the building, immediately notify them of the fire. Yell, knock on doors, or activate fire alarms to alert others and ensure they are aware of the danger.
- Escape if possible: If the fire is small and contained, and you can safely escape, do so immediately. Follow your predetermined escape plan and evacuate the building as quickly as possible. Crawl low to the ground where the air is less smoke-filled.
- Check doors for heat: Before opening any doors, check them for heat with the back of your hand. If a door is hot, do not open it as it could indicate fire on the other side. Find an alternative route or remain in a safe area and seal the door with towels or clothing to prevent smoke from entering.
- Stay low in smoke-filled areas: Smoke is the leading cause of fire-related deaths. If you encounter smoke during your escape, stay low to the ground where the air is clearer. Cover your nose and mouth with a cloth or a damp piece of clothing to reduce smoke inhalation.
- Use exits and fire escapes: Follow designated exit routes and use stairwells, fire escapes, or designated emergency exits to evacuate the building. Avoid using elevators, as they can malfunction during a fire.
- Communicate with firefighters: Once outside, if emergency responders are on the scene, inform them of anyone who may still be inside the building. Provide them with accurate information to assist in rescue efforts.
- Don’t re-enter the building: Once you have safely escaped a burning building, do not attempt to re-enter for any reason. Let the firefighters handle the situation and provide them with any pertinent information you have about the building or occupants.
Additional tips for fire safety:
- Develop a fire escape plan: Create a detailed escape plan for your home or workplace and practice it regularly with all occupants.
- Install and maintain smoke alarms: Ensure that smoke alarms are installed in every room and on every level of your home or workplace. Test them regularly and replace batteries as needed.
- Stay low in smoke: Remember that smoke rises, so staying close to the ground during a fire can improve your chances of breathing cleaner air.
- Preventative measures: Take precautions to prevent fires, such as keeping flammable materials away from heat sources, not leaving candles or cooking unattended, and having fire extinguishers readily available.
- Educate yourself: Familiarize yourself with fire safety procedures and learn how to use a fire extinguisher properly.
Remember, the most important priority in a fire emergency is your personal safety. If in doubt, evacuate the area and seek professional help.
Proof: Science of Alcohol
Here are some key take-outs from Proof: The Science of Booze. Did you know that:
- Yeast is key in making booze, it converts sugar into ethanol and carbon dioxide
- Yeast is a single-celled organism, it’s neither plant nor animal, neither bacteria nor virus, it’s a fungus
- Yeast is the first creature to have its genome sequenced
- Alcohol gets absorbed better when injected into the intestines, imagine how this study was performed…
- Hangovers are still a mystery, and nobody has a cure for it
- Distillation was discovered over 2000 years back
- Scientists and Engineer discovered many things while studying alcohol
- There is a lot of research done on booze, not with (that’s for philosophers ;))
Hyperthyroidism
Hyperthyroidism is a condition characterized by the overproduction of thyroid hormones by the thyroid gland. Thyroid hormones regulate various functions in the body, including metabolism, heart rate, and body temperature. When there is an excessive production of thyroid hormones, it leads to an accelerated metabolism and a range of symptoms. The most common cause of hyperthyroidism is an autoimmune disorder called Graves’ disease.
Symptoms of hyperthyroidism may include:
- Weight loss despite increased appetite
- Rapid or irregular heartbeat
- Tremors or shaking
- Increased sensitivity to heat
- Excessive sweating
- Nervousness, anxiety, or irritability
- Fatigue or muscle weakness
- Changes in bowel patterns, such as frequent bowel movements
- Changes in menstrual patterns in women
- Enlarged thyroid gland (goiter)
- Eye problems (Graves’ ophthalmopathy) like bulging eyes, eye irritation, or vision changes.
The treatment of hyperthyroidism aims to reduce the production of thyroid hormones and manage the symptoms. Common treatment options include:
- Antithyroid medications: Medications like methimazole or propylthiouracil (PTU) can help reduce the production of thyroid hormones. These medications are typically taken for a specified period, and their effectiveness is monitored through regular blood tests.
- Radioactive iodine therapy: Radioactive iodine is administered orally, and it selectively destroys the cells of the thyroid gland that produce thyroid hormones. Over time, this leads to a decrease in hormone production. This treatment is often a long-term solution but may lead to hypothyroidism (underactive thyroid) in some cases.
- Beta-blockers: Medications such as propranolol or atenolol are used to manage the symptoms of rapid heartbeat, tremors, and anxiety associated with hyperthyroidism. These medications do not directly affect thyroid hormone levels but provide symptomatic relief.
- Surgery (thyroidectomy): In some cases, surgical removal of all or a portion of the thyroid gland may be necessary, especially if antithyroid medications and radioactive iodine therapy are not suitable or effective. After a thyroidectomy, lifelong thyroid hormone replacement medication is necessary to maintain normal hormone levels.
The choice of treatment depends on various factors, including the underlying cause, the severity of symptoms, the individual’s age, and any associated health conditions. It is important for individuals with hyperthyroidism to work closely with their healthcare provider to determine the most appropriate treatment plan and to receive regular follow-up care to monitor thyroid hormone levels and manage symptoms effectively.
Heart Attacks
Almost all causes of sudden collapse are from the heart, from some
condition that suddenly stops the heart from beating. The most
common cause of this is what is colloquially called a heart attack,
or myocardial infarction (MI). This is when a lack of blood ow
to the heart muscle itself causes the death of heart muscle cells.
It’s often accompanied by a sudden change in the heart rhythm, a
so-called arrhythmia. Instead of the heart beating in an organized
way that effectively pumps blood, it just kind of quivers.
No blood ow to the brain means that the body will collapse and
die quickly. Sudden arrhythmias can also occur because of other
conditions, including genetic predispositions to sudden death that
can run in families.
Historically, heart attacks have been thought of as a disease of a
certain kind of person: usually, a successful, driven, type A kind of
man. However, heart attacks are in fact the leading cause of death
among women.
Although our ability to deal with and treat a heart attack has become
increasingly effective, we’re still seeing an increasing impact of
heart disease. This is mostly because it is so dif cult to effectively
modify well-known risk factors for atherosclerotic heart disease.
The heart is, essentially, a muscle—a not-too-large muscle, but one
that has to contract and relax and contract and relax, continuously,
without a rest. Like any other muscle or living tissue, the heart
needs oxygen, carried by blood though the coronary arteries that
course along the surface of the heart. If these coronary arteries get blocked, there won’t be enough blood ow or oxygen, and parts of
the heart muscle itself will be damaged or killed.
The most common reason for blockage of ow though the coronary
arteries is atherosclerosis: the buildup of plaques along the walls
of the coronary blood vessels. A similar process can occur in blood
vessels leading to the brain, causing stroke, or to other blood
vessels affecting other organs. Therefore, the risk factors for stroke
and heart attack overlap in many ways.
It’s commonly thought that atherosclerotic plaques are made of
fatty deposits, but that is an oversimpli cation. Although fats, or
lipids, do contribute to these plaques, there are also in ammatory
cells, scarring, and clotting cells and proteins that contribute to
the plaques.
These so-called atheromas start to develop in the teens and twenties
and slowly proliferate. Longstanding, stable blockages can lead to
the natural development of collateral vessels—new vessels that can
bypass the blockage to deliver blood. Atherosclerotic plaques can
lead to symptoms in several different ways.
Treating Cancer
Surgery is the primary, main therapy for breast cancer, and surgery
alone can be curative when breast cancer is caught early. After
surgery, many women with early cancer pursue what’s called
adjunctive therapy, which refers to things done in addition to the
primary therapy—surgery—to increase the chance of cure or longterm
survival.
Although theoretically an early cancer shouldn’t have spread to
outside tissue, we can’t know if a few cancer cells have snuck out—
and even a few cells, or one cell, can continue to grow and allow
cancer to spread. Adjunctive therapy for breast cancer includes
mainly chemotherapy, hormonal therapy, and radiation.
Chemotherapy refers to drugs given to kill cancer cells or halt their
spread. It’s most effective on rapidly dividing cells, and different
kinds of breast cancer may be more or less sensitive to chemo.
The chemotherapy drugs are often more effective when used in
combinations. Although side effects may be very dif cult, we have
gotten better at managing many of them.
Many, but not all, breast cancer cells have receptors for female
hormones. If they do, medications to block hormones can prevent
cancers from spreading.
Radiation therapy can also be used to destroy rapidly dividing
cancer cells, though there are side effects and dose limitations.
These adjunctive therapies can be used to increase the chance of
long-term survival or as palliative therapy to extend life and provide
comfort, even in patients who cannot be cured.
Talking to paramedics about burns
More ambulances have pulled up, there’s plenty of help on the
scene, and it’s time to arrange transport.
The paramedic asks you
about your patient’s status. This is your quick summary, just the
facts: “Vitals normal, she’s ambulatory and talking, her voice
is hoarse and she’s coughing. She was in an enclosed room with smoke. One large second- to third- degree burn on her leg, estimate
6% BSA.” The paramedic nods and instructs you to get her on an
ambulance and ride with her.
•• Let’s go through that quick summary—what you reeled off to the
paramedic, the most essential things she needed to know. You
started with, “Vitals normal”—that reflects those crucial ABCs.
Then the phrase, “she’s ambulatory and talking” describes her
overall functioning and mental status. Ambulatory and talking is
much more reassuring than comatose or unable to speak.
•• You also mentioned that she’s hoarse and coughing—that was to
express the findings that make you worry about potential smoke
inhalation. You also mentioned the large burn, and the location.
Location is important, because burns on the neck, chest, or face can
lead to additional complications from problems with breathing and
circulation. Then you said an estimate of the burn size, saying, “6%
BSA,” or 6% body surface area.
•• That estimate is based on the “rule of 9s,” a shorthand way of
estimating burn size. It breaks an adult’s body up into percentage
zones, each of which is a multiple of 9 to add up to 100%. The
head, front and back, is 9%; each arm is 9%; each leg is 18%; and
the entire torso is 36%. Our patient had a large burn of the lower
extremity, on her thigh and leg. The whole lower extremity would
be 18%, and we figured her burn covered about a third of that, for
an estimated burn size of 6% of her total body surface area.
•• An accurate burn size estimate is important. Larger burns are more
likely to lead to big inflammatory changes requiring advanced
support, and larger burns will require more-aggressive fluid
management. Burns always lead to a loss of fluids, both directly
from the exposed burn but also from fluid seeping out of the
circulation into the tissues around the burn. So an accurate estimate
of burn size helps with triage—who needs what level of care the
fastest?—and with starting appropriate fluid management.
Proof Conclusions
- During a study of blind smelling odors, amateur drinkers got on average 7.5 out of 10 odors right and pros got 8.6 out of 10 right
- Power of suggestion plays a role in the tasting, you will taste what others suggest or because you already know your drink
- Our senses are limited, we can smell a single flavor excellent, but it becomes hard when we mix flavors
- The shape, size, and visuals of the glass influence your taste
- The color of your drink influences your taste
- Study shows that adding tasteless artificial colors makes the drink taste different
- Taste and smell aren’t well-defined and they’re hard to describe
- Professor Noble invented a flavor map, the “Noble Wine Aroma Wheel” to describe flavor easier and faster for her research
- Tasting gets influenced by your environment or setting, your wine tasted so much better at the vineyard on your holiday…
- A flavor smells or tastes like something, it doesn’t mean it’s in there
- When you taste, you remember a flavor that is stored in your memory and your brain links to it
- Everyone taste different, a drink can taste fantastic to one person but shitty to another
cellulitis symptoms and treatments
Cellulitis is a bacterial skin infection that typically affects the deeper layers of the skin and the underlying tissues. Here are the symptoms and treatments for cellulitis:
Symptoms of Cellulitis:
- Redness: The affected area may appear red, swollen, and warm to the touch.
- Pain and tenderness: The area can be painful and tender, especially when touched or pressed.
- Swelling: Swelling may occur around the affected area.
- Skin changes: The skin may become tight, shiny, or stretched, and there may be a change in texture.
- Skin rash: Some people may develop a rash that spreads and blisters.
- Fever and chills: In more severe cases, individuals may experience fever and chills.
Treatment of Cellulitis:
1. Antibiotics:
- Oral antibiotics: Mild to moderate cases of cellulitis can often be treated with oral antibiotics. Commonly prescribed antibiotics include cephalexin, dicloxacillin, or clindamycin. It’s important to complete the full course of antibiotics as prescribed.
- Intravenous (IV) antibiotics: If the infection is severe, spreading rapidly, or if oral antibiotics are not effective, hospitalization may be required, and antibiotics may be administered through an IV.
- Wound care:
- Cleaning: Keep the affected area clean by washing it gently with mild soap and water.
- Moisturizing: Apply a mild moisturizer to prevent excessive dryness and cracking of the skin.
- Bandaging: In some cases, a sterile bandage or dressing may be recommended to protect the affected area.
- Elevating the affected area: Elevating the affected limb or area can help reduce swelling and promote better circulation.
- Pain management: Over-the-counter pain relievers, such as acetaminophen or ibuprofen, can help alleviate pain and reduce inflammation. Follow the recommended dosage and consult with a healthcare professional if needed.
- Follow-up and monitoring: It’s important to follow up with a healthcare professional to ensure proper healing and monitor for any complications. They may need to reassess the infection and adjust the treatment if necessary.
In some cases, cellulitis can lead to complications such as the spread of infection to the bloodstream or the development of an abscess. If you suspect you have cellulitis or if the symptoms worsen despite treatment, it is crucial to seek medical attention promptly. A healthcare professional will provide an accurate diagnosis and recommend the most appropriate treatment based on the severity and location of the infection.
Arnold - Belly Pain
Arnold
•• The last case on our shift today is a 55-year-old man, Arnold, with
a chief complaint of belly pain. Arnold says his pain started a few
days ago and is now constant. It’s on the right side, up high in the
belly. He also thinks he’s been running a fever today—he’s felt at
times sweaty or chilled. We need more story; the OLD CAAAR
mnemonic can help:
○○ Onset: a few days ago.
○○ Location: the right upper belly.
○○ Duration, this pain is pretty much constant now.
○○ Character: a sharp sort of pain.
○○ Alleviators: none. He tried antacid and that didn’t work.
○○ Aggravators: It hurts to breathe in, especially to breathe in
deeply.
○○ Activity at onset: Arnold doesn’t remember what he was doing
when this started.
○○ Radiation: none. The pain doesn’t move or shoot or point
anywhere else.
•• It’s abdominal pain, but the story doesn’t fit—it doesn’t sound like
there’s anything wrong in the abdomen. Let’s see what the physical
exam shows. His heart rate and respiratory rate are fast, though
those might be abnormal because of his elevated temperature. One
simple and reasonable step worth taking is to give Arnold a dose
of ibuprofen. That will safely reduce his fever, and we’ll be able to
reassess those vitals.
•• Otherwise, on Arnold’s physical exam, everything seems normal.
His belly is not at all tender, and his lungs are clear and unlabored—
he’s breathing a little fast, the vital signs say, but he’s not having
any difficulty breathing.
•• Arnold mentioned that his pain worsens with breathing. Is there
something wrong in his lungs, or with his diaphragm—something
pressing there that hurts more when he moves it? We need a look at
his lungs, and the test we need is a chest X-ray.
•• The chest X-ray shows an area of increased density, called a
consolidation, right at the bottom of his right lung, up against the
diaphragm. That’s pneumonia, an infection of the lung, and the
consolidation we see on X-ray is infected fluid, or pus. That’s what
hurts, and that’s what hurts more when he breathes in. Arnold feels
the pain in his belly, but the disease process is at the bottom of
his chest. That’s not so unusual. You might expect pain to reliably
happen exactly where the pathology is. But pain sensations don’t
always correlate exactly with where the pain originates.
Beer to Whiskey
In a basic sense, all whiskey begins life as beer. Whiskey distillers start by fermenting grains (just like beer brewers do) to release sugars that yeast will eventually convert into alcohol. But, the primary difference with whiskey is that this fermented product is never intended to be drank. So, producers never refine the mixture with additional ingredients, like hops. What sets all beer spirits apart is that, before distillation, the beer has been finished in a way that makes it drinkable—identical to the kind of brew you’d find in a six-pack on store shelves.
And there’s a reason most beer rarely becomes a spirit. Working with a finished beer product is what makes beer spirits so unique, but it’s also what makes them more costly, both to produce and, ultimately, to buy. “You get a 6,000 gallon tanker of delicious gold medal-winning IPA. That’s a huge expense,” Karakasevic explains. “And then you have to sit on it for like two, three, four, six, 10, 12 years and watch it evaporate away. You’re losing three to four gallons a year, and after 10 years, fuck, there’s 40 gallons gone out of one barrel. So your yield goes down and your cost goes up, and it’s harder to sell a $75 bottle of whiskey because everyone likes to spend $35.”
Treat Eye Infection
The treatment of an eye infection depends on the specific type and severity of the infection. However, here are some general guidelines for treating common eye infections:
- Maintain good hygiene: Wash your hands thoroughly with soap and water before touching your eyes or applying any medications.
- Warm compresses: Applying a warm compress to the affected eye can help soothe the symptoms and reduce inflammation. Dip a clean cloth or cotton pad in warm water, wring out excess moisture, and gently place it over the closed eyelid for a few minutes. Repeat this several times a day.
- Eye drops or ointments: Over-the-counter or prescription eye drops or ointments may be recommended to treat the infection. These medications can help relieve symptoms and fight the underlying infection. Follow the instructions provided by your healthcare provider or the product label for proper usage.
- Avoid wearing contact lenses: If you wear contact lenses, it’s best to avoid wearing them until the infection clears up. Contact lenses can worsen eye infections and prolong the healing process. Replace your contact lenses and lens case to prevent reinfection.
- Avoid rubbing or touching your eyes: Rubbing or touching your infected eye can further irritate the area and spread the infection. Try to resist the urge to touch your eyes and avoid any activities that may introduce dirt or bacteria into the eyes.
- Practice good eye hygiene: Keep your eyes clean by gently washing them with a clean cloth and warm water. Avoid sharing towels, pillows, or other personal items that may come into contact with your eyes.
- Seek medical attention: If your symptoms worsen, persist, or if you have severe pain, blurred vision, or discharge that is thick, pus-like, or bloody, it’s important to seek medical attention promptly. Your healthcare provider can diagnose the specific type of eye infection and prescribe appropriate medications or treatments.
It’s crucial to remember that these guidelines are general and may not be suitable for all eye infections. It’s best to consult with a healthcare professional for an accurate diagnosis and personalized treatment plan based on your specific condition.
Diabetes treatment and weight control
The treatment of diabetes is primarily concerned with achieving
euglycemia—that is, a normal blood sugar during, after, and
between meals. In type 2 diabetes, first-line therapy is losing weight
and improving exercise habits. Sometimes, these steps alone can be
sufficient to essentially “cure” diabetes.
More typically, though, medications
are necessary. These include
oral medicines—so-called oral
hypoglycemics—that increase insulin
sensitivity, increase insulin release,
or both.
In many patients with type 2 diabetes, insulin must also be administered, typically by one or more daily injections. Type 1 diabetics, who lack any of their own insulin, must rely on injections. The treatment of diabetes also requires frequent home glucose monitoring with finger sticks.
A more advanced treatment strategy, more typically used for type
1 diabetics, is an insulin pump to administer a constant ow of
insulin to the body, similar to the way a healthy pancreas secretes
insulin. There’s also technology available to continuously monitor
blood sugar.
Though tight control—that is, using intensive therapy to keep blood
sugar close to normal—has been shown to best prevent the longterm complications of diabetes, it comes at a price. Deciding how
tightly to control blood sugar depends on such factors as the life
expectancy of the patient, the overall health and other risk factors,
and an honest assessment of compliance and a patient’s ability to
self-medicate.
With the exception of a few patients with new-onset type 2 diabetes
who successfully lose weight and improve their exercise habits,
most patients with diabetes require lifelong active management.
Diabetes is a good example of a disease whose treatment requires
not just taking pills and visiting the doctor, but also taking charge of
your health and making changes in your life.
Effective weight control involves primarily changing the diet to
consume fewer calories. Many different styles of diet have been
proposed and studied, including ones that especially discourage
carbohydrates or that stress consuming more foods with lower
energy content. The best predictor of success isn’t which diet is
followed, but whether changes in habits can be sustained for years.
Although exercise alone is usually ineffective in leading to weight
loss, exercise combined with dietary changes works better than diet
alone. Medications can sometimes be an additional part of a weight loss
program, but none are really ideal or particularly effective.
Objectively, the most effective therapy for weight loss for obese
patients is surgery. This is a fast-growing field called bariatrics,
and it involves a variety of surgical options to lower the stomach volume or bypass some of the digestive and absorptive parts of the
intestine—or both.
Although the results of bariatric surgery can be impressive,
surgery will not be successful without the patient committing and
following through with lifestyle changes as well. Bariatric surgery
also entails considerable risks, so it’s really only offered to people
with severe obesity or who are already suffering from health
consequences of their weight.
Influenza Pneumonia
Pneumonia is commonly understood as a bacterial infection in
the lungs, but it can be caused by viral or fungal or other kinds
of infections, or sometimes by noninfectious things like chemical irritants or an immune-mediated inflammatory reaction.
In most circumstances, though, pneumonia is caused by infection of the lung tissue—infection that causes an accumulation of fluid and debris that leads to coughing and fever.
Lung tissue itself is particularly prone to infection, because we’re constantly breathing in air and bringing in whatever we breathe.
Also, the air sacs in the lungs are normally a little moist, and that
warm, moist mucus is a breeding ground for microorganisms.
Fortunately, we have immune systems to keep infection away.
There are also little hair cells that beat up and down to keep mucus moving around and out so that it won’t get infected easily. But advancing age, lung damage from mild infections, asthma, and many other conditions can compromise lung integrity, increasing the risk of pneumonia.
Influenza, the infection itself, causes fever and cough, so how
can we tell it has turned into pneumonia? The time course of the symptoms is a crucial clue. Influenza usually includes about five days of fever that gradually decline. Increasing fevers after a
few days often indicates a second, superimposed infection like pneumonia. Cough that’s getting much worse is another clue.
On the physical exam, a patient with pneumonia—influenza pneumonia or any pneumonia—will often be breathing rapidly.
There may be signs of increased difficulty breathing, such as pulling in the ribs with each breath, and the breath sounds themselves heard
through a stethoscope will sound
crackly and abnormal.
Sometimes, a chest X-ray is done to confirm pneumonia. It will show an area of brightness where the X-ray beam is blocked by the accumulated infected fluid. The bigger the area of brightness, the worse the pneumonia
(though there isn’t a 100
percent correlation).
X-rays can also be done to
monitor therapy for pneumonia
to ensure improvement.
However, chest X-rays aren’t perfect. The findings on the lm can lag a day or so behind what’s going on with the patient, so very
early pneumonias may not be seen yet.
Although pneumonia in young, healthy patients can usually be treated as an outpatient, in older or ill people, it may require hospitalization and extra support with oxygen. Pneumonia remains a significant cause of death in the developed world, often contributing
to illness and decline in people with other health problems but
occasionally killing someone who was otherwise well.
In the case of influenza pneumonia, the secondary pneumonia itself can be caused by the flu virus invading the lung tissue or by secondary bacterial infections by bacteria that happened to be
nearby and have taken advantage of the patient’s illness to cause another infection.
Celiac Disease
Celiac disease is a chronic disorder that causes malabsorption of
nutrients from the gut, leading to a myriad of symptoms that can
include fatigue, anemia, and almost any GI symptom. In celiac
disease, malabsorption of nutrients can also affect the bones—
decreased absorption of dietary Vitamin D, phosphorus, and
calcium can cause decreased bone density.
With celiac disease, the lining of the gut—the small, ngerlike
projections where absorption of food nutrients occurs—is damaged,
and the net effect is that nutrients are not absorbed across the gut
wall into the blood for use by the body.
The primary symptoms of celiac disease are caused by inadequate
nutrient availability and also by the GI effects of having, essentially,
food staying in the gut instead of moving into your body. This
includes diarrhea, bloating, and abdominal pain.
Sometimes, constipation can be more of a problem than diarrhea,
or—as in the case of the 55-year-old patient—there can be periods
of time when these seemingly opposite symptoms go back and
forth. Many celiac symptoms also occur outside of the gut.
Celiac disease was known to the ancient Greeks, who referred to a condition called koiliakos, meaning “suffering of the bowels.”
A patient case written in the second century described a man with stomach pain who was underweight, pale, weak, and incapable of working—which is still a pretty good description of a severe case in modern times. The Greek term was translated to the term “celiac”
in 1856.
Around that time, it was recognized that this was a disease that
could be managed by diet. In 1954, Dutch pediatrician Willem
Dicke linked the disease to the ingestion of wheat protein. It’s
speculated that his experience seeing patients improve during the
famine of 1944, when wheat was scarce, may have helped him
recognize the critical role of wheat in this illness.
Though the symptoms of celiac disease are varied and affect many
organ systems, it only has one cause: ingesting certain proteins
found in wheat, barley, and rye. These are natural proteins from a
family called gluten proteins. Celiac disease is sometimes called
“gluten enteropathy” or “celiac sprue.”
When gluten-containing foods are eaten by people with celiac
disease, these proteins are modi ed or processed so that they trigger a cross reaction with gut tissue. Basically, the body’s own
immune system is tricked into attacking healthy cells in the gut
(and probably elsewhere, too).
Celiac disease is in a sense an autoimmune disease—the body
attacks itself—but it’s an autoimmune disease that has speci c and
avoidable trigger. It’s the gluten proteins that trigger the reaction,
and once gluten is no longer part of the diet, the disease itself can
almost always be reversed.
TREATMENT & DIAGNOSIS
Treatment and Diagnosis of Celiac Disease
The treatment of celiac disease is, simply enough, a gluten-free
diet. However, because wheat-based products are very common
in a typical Western diet, a gluten-free diet might not be so simple
in practice. Though wheat is the main food to avoid, people with
celiac should also not eat barley or rye, and it’s often suggested that
oat products be avoided, too, because typically harvested oats are
often contaminated with wheat grains that presumably blow across
the crops.
At this time, there are no medications to prevent or treat the
autoimmune damage that occurs when wheat is ingested, and
people with celiac need to avoid eating gluten-containing products
for the rest of their lives. Avoiding wheat not only helps relieve the
immediate symptoms of celiac disease but also reduces the risk
of long-term complications of untreated celiac disease, including
osteoporosis and an increased risk of cancer.
For many years, the only way to diagnose celiac disease was by
small intestinal biopsy. Dr. Dicke, who made the link with wheat
after World War II, also rst described the “villous atrophy”
characteristic of celiac disease when biopsies are examined under
the microscope. Biopsies are still used to de nitively diagnose
celiac and to monitor patient’s progress.
However, the availability of reliable, relatively inexpensive blood
tests to diagnose celiac has changed our approach to this disease.
Hepatitis and Cirrhosis
Cirrhosis and hepatitis are two related conditions that can affect the liver. Hepatitis refers to inflammation of the liver, while cirrhosis is a progressive and irreversible condition characterized by scarring and liver damage. Hepatitis can be a cause of cirrhosis, particularly when left untreated or chronic. Here are the symptoms and treatments for each condition:
Hepatitis:
1. Symptoms:
- Fatigue and weakness
- Jaundice (yellowing of the skin and eyes)
- Abdominal pain or discomfort
- Loss of appetite
- Nausea and vomiting
- Dark urine
- Pale or clay-colored stools
- Joint pain
- Fever
- Treatments:
- Antiviral medications: For viral hepatitis (such as hepatitis B or C), antiviral medications may be prescribed to reduce viral replication and prevent further liver damage.
- Supportive care: Rest, maintaining hydration, and a healthy diet are important for supporting the liver’s recovery. Avoiding alcohol and certain medications that can further harm the liver is also crucial.
- Vaccinations: Vaccinations are available for hepatitis A and hepatitis B, which can help prevent these infections.
Cirrhosis:
1. Symptoms:
- Fatigue and weakness
- Jaundice
- Itchy skin
- Abdominal pain and swelling
- Easy bruising and bleeding
- Weight loss and muscle wasting
- Nausea and vomiting
- Changes in appetite and taste
- Confusion or mental changes (in later stages)
- Fluid retention and swelling in the legs (edema) or abdomen (ascites)
- Treatments:
- Management of underlying causes: Treating the underlying causes of cirrhosis, such as chronic hepatitis, alcohol abuse, or nonalcoholic fatty liver disease, is crucial to prevent further progression.
- Lifestyle changes: Avoiding alcohol consumption is essential, as alcohol can worsen liver damage. A healthy diet, weight management, and regular exercise are recommended to support liver health.
- Medications: Medications may be prescribed to manage specific symptoms or complications of cirrhosis, such as diuretics to control fluid retention or medications to manage hepatic encephalopathy (mental changes).
- Liver transplantation: In advanced cases, liver transplantation may be considered as a treatment option.
It’s important to note that these conditions can have overlapping symptoms and may require medical evaluation for accurate diagnosis and appropriate treatment. Chronic hepatitis can progress to cirrhosis if left untreated, emphasizing the importance of early diagnosis and management of hepatitis infections. If you suspect you may have hepatitis or cirrhosis, it is essential to consult with a healthcare professional for proper evaluation and guidance.
Before Travelling
Learn about Terrain
Learn about cultural abnormalities
HIV - Testing and Treatment
The most commonly used test for HIV is a blood test for antibodies
to the virus, which usually becomes positive 3 to 12 weeks after
infection during seroconversion (which is when the serological
tests—the serum tests for antibodies—become positive). This delay
in positivity means that someone with acute HIV, a new infection
with symptoms, may still have a negative HIV test.
In cases of suspected acute HIV, before seroconversion, a test for
HIV genetic material in the blood using the polymerase chain
reaction (PCR) technique can show infection. This same test,
sometimes called the viral load, can also be used to see how heavily
the blood is infected and, thus, how contagious a person might be.
Another test commonly used in the evaluation and follow-up of an
HIV patient is a CD4 count, a count of the T helper lymphocytes
that are destroyed by HIV infection. A normal CD4 count is around
800 to 1,200; in advanced HIV and AIDS, this trends into the 100s
or eventually down to zero.
The most effective treatment of HIV starts early. There are
medicines that can prevent the initial transmission of HIV—this
can be used during the birth of a baby to an HIV-positive mom,
after an inadvertent needlestick blood exposure for a health-care
worker, or after an unsafe sexual encounter.
When an HIV infection is diagnosed, there are about 30 different
anti-HIV medications to stop the spread of the virus. These are
used in a variety of combinations to make them more effective
and also to prevent the virus from developing resistance. Current
HIV medications need to be taken every day for the rest of a
patient’s life.
We also have a number of medications to prevent and treat the
opportunistic infections that cause a lot of the suffering in AIDS
patients. Again, these need to be taken long term. Medication regimens for AIDS and HIV patients can be complex and expensive and may lead to signi cant side effects. It’s also crucial to help
people with HIV infections maintain good overall health and
nutrition and to take steps to prevent transmission to other people.
Steps of security E & E
What to do in disaster:
- Immediate Security
- Self check./ Medical Attention
- Protection - Find a gun or a weapon.
- Physical Needs - Shelter, Water, Fire, Food.
- Communication - More for moral. Call people to reassure them
- Transit to safety
Endometriosis
Endometriosis is common. Probably about 15 percent of women
have some degree of endometriosis, though the extent and severity of
symptoms vary greatly. The normal endometrium is the lining of the
uterus—tissue comprised of glands, blood vessels, and connective
tissue that thickens and is then shed during each monthly cycle.
In some circumstances, this endometrial tissue is found outside
of the uterus—on the inside wall of the abdomen, on the ovaries,
or nearby. It’s unclear how this tissue gets there. It could spread
during menstruation, or cells could spread though lymphatic or
blood vessels. The cells of endometriosis are normal cells, just in
the wrong place; this is referred to as “ectopic” tissue.
These misplaced areas of endometrial tissue are what cause the
symptoms of endometriosis. Pain is caused in part from bleeding,
which may be cyclical. Recurring bleeding cycles can lead to
scarring, especially because unlike bleeding in the uterus, the blood
from endometriosis cannot be expelled from the body. However,
the extent of endometriosis, the amount of ectopic tissue observed,
doesn’t always correlate with the degree of pain women experience.
Dyschezia, or painful passage of stool, is a characteristic symptom
of endometriosis, and it is also caused directly by the presence of
endometrial tissue near the distal colon and by resulting scarring
and adhesions. Women with endometriosis may experience painful
symptoms intermittently, and they may or may not vary with their
menstrual cycle.
About 30 to 40 percent of women with endometriosis have
problems with impaired fertility, perhaps also related to scarring
and adhesions that alter the positioning of the ovary and fallopian tubes. However, even mild degrees of endometriosis, without
signi cant scarring, can lead to infertility.
The treatment of endometriosis needs to be tailored to the individual
case. Medical options include the use of a variety of hormone
strategies to reduce the development of endometrial tissue, or to stop
menses altogether. There are also surgical approaches to removing
or destroying the ectopic endometrial tissue through minimally
invasive, laparoscopic procedures. While this can be effective in
reducing pain and restoring fertility, the degree of success can be
dif cult to predict.
Laparoscopic approaches have the advantage of a much quicker
recovery, less pain, less scarring, and a reduced risk of bleeding
than traditional abdominal surgery. However, they may take a little
longer, and not all procedures can be done using small laparoscopic
tools. The surgeon also loses the ability to feel and use his or her
hands directly.
There are also even more advanced minimally invasive techniques,
using devices to robotically assist the surgeon through even smaller
or fewer openings, or even by using openings through normal body
ori ces, such as through the wall of the esophagus.
A Legend
Cover for your actions. As a CIA operative it. This includes a story, papers, facts and documents. Be congruent with your actions/story. Use a scepter of authority to blend in with any crowd. Anonymously anothority symbols are keys, clipboards, nametags and keycards. Fedex is also a good sceptor.
You can also be untouchable/invisible - If you’re homeless you cant go inside anywhere. Watch your shoes and watches.
When should you leave a wound open vs close it.
The decision to close a soft tissue wound or leave it open depends on several factors, including the type, location, size, and severity of the wound. Here are some general guidelines:
- Closure (stitches, staples, adhesive strips):
- Clean, minor wounds with straight, well-aligned edges.
- Wounds in areas that are prone to movement and require good cosmetic results (e.g., face).
- Wounds that are less than 6-8 hours old (to reduce the risk of infection).
- Deep wounds that require support to heal properly.
- Wounds that have a higher risk of infection if left open. - Leaving the wound open (secondary intention healing):
- Large, gaping wounds that are difficult to close primarily.
- Wounds with a high risk of contamination or infection.
- Wounds with significant tissue damage or signs of infection.
- Wounds that are more than 6-8 hours old and carry a higher risk of infection.
- Infected wounds or wounds that have foreign bodies or extensive tissue loss.
It’s important to note that these are general guidelines, and the decision to close or leave a wound open should ultimately be made by a healthcare professional. They will evaluate the specific characteristics of the wound and consider other factors such as the individual’s overall health, risk of infection, and potential complications.
Prompt medical attention is advised for deep, large, or contaminated wounds, as they may require professional evaluation and appropriate wound management to prevent complications and promote proper healing.
Treating Migraines
Dealing with migraines should always start with prevention. Many
(though not all) migraines have speci c triggers. These can include
lack of sleep, hunger, dehydration, stress or illness, or sometimes
bright lights or reading while in a car.
People who have migraines should track their episodes and see if
some of these common triggers seem to be part of the problem.
Not all migraine sufferers have all of these triggers, but many have
at least some, and some of these can be avoided through lifestyle
modi cation, stress reduction, yoga, getting a good night’s sleep,
and other nonmedical steps. It’s also very important for people with
migraines to avoid falling into the trap of medication overuse and to
modulate their caffeine intake.
Beyond these preventive lifestyle strategies, migraine sufferers
need an action plan to start as soon as possible when a migraine
begins. For people who do have a warning aura, the migraine action
plan needs to start as soon as the aura begins—which may be well
before the actual headache. A migraine caught early is much more
likely to be stoppable.
A migraine action plan should include both medical and nonmedical
steps. Usually, the patient will bene t from getting to a dark, quiet
environment quickly. Sometimes a small snack, including some
sugar, will help, perhaps even including some soda or coffee with
caffeine. Although habitual caffeine use can lead to migraines,
when taken at the start of a migraine, caffeine can help reduce
its severity.
Medicines can help, especially if taken at the start. These
can include over-the-counter pain relievers like ibuprofen or
acetaminophen. There are also very effective prescription migrainestopping
medicines. The best of these are in a family called the
triptans. They all work similarly to block the brain receptor that is
central to migraine development.
All migraine sufferers who don’t get full relief from over-thecounter
products should have one of these triptans available for immediate use when a migraine begins. They come as pills and
nasal sprays and in auto-injector devices that are especially useful
for the many migraine patients who have vomiting with their
headaches. Triptans, though very effective, can trigger rebound
headaches if used too frequently.
If, despite trigger avoidance and a good action plan, migraines
are still occurring frequently, we ought to consider starting a daily
migraine prevention strategy. This can involve adding a daily
medication that can act as a migraine preventer. There are several of
these available, though some can have side effects.
There are also some more natural and potentially safer approaches
to daily migraine prevention, including daily vitamin B2 or
magnesium supplements. Some studies have shown these to be
quite effective in preventing migraines.
Stroke symptoms
•• Gabriel’s likely diagnosis is a stroke, also called a cerebral
infarction, on the left side. A stroke results from an impaired blood
supply to an area of brain. This causes an onset of focal neurologic
deficits, corresponding to the loss of function of that brain area.
Usually, the blood supply is interrupted by an occluded or closed-up
vessel—typically from a blood clot or plaque. Sometimes, strokes
can be caused by a ruptured blood vessel, causing bleeding and a
loss of blood supply to one area.
•• The key to stroke management is to quickly reestablish blood flow,
minimizing cellular death. Early steps in management include
the ABCs, and treating life-threatening complications like brain
swelling or prolonged seizures. An emergency CT is needed to
exclude bleeding in the brain.
•• Once you know there’s no bleeding, clot-busting therapy can be
offered if appropriate. However, breaking down the clot medically
with a clot buster will only help if there is still viable brain tissue
there.
•• In most circumstances, we have three hours to reestablish blood
flow to a brain area if we hope to prevent cellular death. But what
about Gabriel—how long does he have?
○○ Your nurse suggests Gabriel’s wife call one of his coworkers
to find out when he was last seen. It turns out that Gabriel left
work late today, and was in perfectly good health when he
left about 90 minutes ago. So he had to have had his stroke
between his arrival home, about 60 minutes ago, and when his
wife found him—certainly less than three hours ago.
How to stitch a wound
Stitching up a wound should ideally be performed by a healthcare professional. However, here are the general steps involved in stitching up a wound:
- Preparation:
- Wash your hands thoroughly with soap and water or use hand sanitizer.
- Put on sterile gloves and other appropriate personal protective equipment (PPE) if available. - Cleanse the wound:
- Gently clean the wound with sterile saline solution or clean water to remove dirt, debris, and bacteria.
- Use sterile gauze or a clean cloth to gently pat the wound dry. - Anesthesia (if necessary):
- Apply a local anesthetic, such as lidocaine, to the surrounding area of the wound to numb the area. This step is typically performed by a healthcare professional. - Wound closure:
- Use sterile instruments (e.g., forceps, scissors) to carefully align the wound edges.
- Depending on the size and location of the wound, choose the appropriate closure method, such as sutures (stitches), staples, or adhesive strips.
- Place the sutures, staples, or adhesive strips in a manner that brings the wound edges together securely but not too tight.
- Tie or secure the sutures, or properly place and secure the staples or adhesive strips, ensuring proper wound alignment and closure.
- Trim any excess suture material, if applicable. - Dressing and wound care:
- Apply a sterile dressing or bandage over the closed wound to protect it from contamination.
- Follow any additional instructions from a healthcare professional regarding wound care, such as applying antibiotic ointment or changing the dressing. - Post-procedure instructions:
- Provide the patient with instructions on how to care for the wound at home, including any specific wound care instructions, signs of infection to watch for, and when to seek medical follow-up.
It’s important to note that these steps are a general overview, and the specifics may vary depending on the type and severity of the wound. Seeking professional medical attention for wound closure is recommended to ensure proper evaluation, treatment, and prevention of complications.
Frequent Cough
Our patient in the general medicine outpatient clinic is Margo, a 49-year-old woman who has come in with her husband with a chief complaint of “I’ve got this cough again.” Margo says that she gets a cough frequently, a bad cough that lingers for weeks, and she keeps seeing doctors, and it gets better, and then it comes back. She thinks this time it’s her allergies, because it’s the fall, and she always gets this cough in the fall.
A cough is one of the most common symptoms that drive visits to doctors. Of course, most coughs are brief, self-limited diseases that people recover from without any specific evaluation or therapy at all. Coughing is a normal protective reflex that clears the lungs of secretions and mucus and inhaled dust. But of course, too much of a cough itself is distracting and aggravating, and it can lead to impaired sleep for both the patient and family.
Some of the most common causes of chronic, prolonged, or recurrent coughing include smoking; both active smoking and passive, secondhand smoke exposure can cause cough. Long-term smokers can develop chronic obstructive pulmonary disease with permanent destructive changes in the lungs. Asthma is also very common and can cause coughing as a main symptom, sometimes along with wheezing, noisy breathing, or shortness of breath. Prolonged cough can also be caused by environmental or occupational pollution. Any cause of chronic postnasal drip (including allergies or sinusitis) can cause an ongoing cough.
Reflux—meaning gastroesophageal reflux, from stomach contents
coming back up—can cause cough, as can some medications
(especially ACE inhibitors, a class of blood pressure medications).
Whooping cough, also called pertussis, is probably one of the most common infectious causes of prolonged coughs in adults.
Frequent, ordinary coughs—just from common cold viruses—can kind of stack up, one after another, and seem like a chronic ongoing cough. We see this in children, sometimes, when they start day care, in young pediatricians starting training, or in teachers or daycare
workers. Children or those who work around children can be
victimized by very frequent viral infections.
Less commonly, prolonged coughing can be from heart disease, chronic lung infections, or tumors or cysts in the lungs or bronchial tubes. Problems outside of the chest have to be considered, too—
such as something in the larynx or throat, or neurological conditions that lead to excessive secretions or an impaired ability to keep the
airways clear.
Also, any sort of immune-compromising condition can lead to recurring or persistent coughing. Occasionally, we see what’s called a psychogenic cough, sometimes related to stress.
We can ask about the quality of the cough, to try to nail down
exactly what it sounds like. There are a few specific coughs that do have very characteristic sounds. Croup is an illness of children— young children and babies mostly—with a cough that sounds like the bark of a seal or a dog. But croup is very uncommon in adults.
Another characteristic cough is the cough of pertussis, or whooping cough. Classically, this is a staccato, one-after-another cough that goes on for a minute or more, followed by one big inspiration—a whoop. But many people with whooping cough don’t actually
sound like that and don’t make that whoop.
There’s also a distinction that can be made between a wet and dry cough. A dry cough is likely related to irritation, or some condition without a lot of excess phlegm; a wet, phlegmy cough is likely related to infection or inflammation, perhaps caused by sinus
disease or allergies.
But there’s a lot of overlap. Pneumonia can sound to some people
wet or dry, and so can asthma. And two people listening to the same
cough often disagree on whether it’s wet or dry. Cough descriptions
are not very reliable or helpful, and they certainly shouldn’t be
something that leads you to narrow down the diagnosis without
corroborating information.
The physical exam reveals that Margo is a healthy woman, overall, but she has an annoying, severe, recurring cough. She also wheezes, at least sometimes, on the physical exam. A wheeze is an almost musical whistling noise that is classically caused by narrowing of the airways in the chest. That can be from a one-time illness—such as pneumonia, where mucus in the airways causes narrowing— or by some kind of tumor or mass that’s pressing on one or more airways.
From Margo’s history, this is a recurrent, come-and-go cough
that is associated with a wheeze that comes and goes. That’s very
suggestive of one single, common diagnosis: asthma. In fact, many of the medications Margo’s been using on and off for years are
actually asthma medications, so doctors have been thinking about asthma before. But apparently this has never been communicated
clearly to Margo.
Spiderbite treatments
Symptoms of spider bites can vary depending on the type of spider and individual reactions. However, most spider bites result in localized symptoms that can include:
- Redness and swelling: The bite area may become red, swollen, and inflamed.
- Pain or discomfort: Spider bites can cause pain or a stinging sensation at the site of the bite. The severity of pain can vary depending on the type of spider and individual sensitivity.
- Itching or rash: Some spider bites can lead to itching or the development of a rash around the bite area.
- Puncture marks or blisters: Depending on the spider species and the bite, puncture marks or small blisters may be present at the site of the bite.
- Development of a necrotic wound: In rare cases, certain spiders, such as the brown recluse or black widow, can cause tissue damage and the formation of a necrotic wound (a wound that turns black and becomes dead tissue).
- Systemic symptoms: Although uncommon, some individuals may experience systemic symptoms such as fever, headache, muscle pain, or abdominal pain. These symptoms are more likely with bites from certain species like the black widow spider.
It’s important to note that not all spider bites cause significant symptoms, and the majority of spider bites are harmless and resolve on their own without medical intervention. However, if you suspect a spider bite from a venomous spider or if you develop severe symptoms, such as widespread rash, difficulty breathing, or muscle cramps, seek immediate medical attention.
Identifying the specific spider responsible for the bite can be challenging, so it’s always a good idea to seek medical evaluation if you’re unsure or concerned about a spider bite.
Most spider bites are harmless and can be treated at home with simple measures. However, if you’re uncertain about the type of spider or if symptoms worsen or persist, it’s important to seek medical attention. Here are general steps for treating spider bites:
- Wash the area: Clean the bite area gently with mild soap and water to reduce the risk of infection. Pat it dry with a clean cloth.
- Apply a cold compress: Place a cold compress or ice pack wrapped in a thin cloth on the bite area for about 10-15 minutes. This can help reduce swelling and provide temporary relief from pain or itching.
- Use over-the-counter creams or ointments: Apply an over-the-counter hydrocortisone cream or antihistamine cream to help alleviate itching and inflammation. Follow the instructions on the product label.
- Take over-the-counter pain relievers: If you experience pain or discomfort, you can take over-the-counter pain relievers like acetaminophen or ibuprofen, following the recommended dosage instructions.
- Keep the bite area elevated: If possible, elevate the affected limb to help reduce swelling.
- Avoid scratching: It’s important to avoid scratching the bite area to prevent skin breakdown and potential infection.
- Watch for signs of infection or allergic reaction: Monitor the bite area for any signs of infection, such as increased pain, redness, warmth, swelling, or the presence of pus. Additionally, watch for signs of an allergic reaction, including difficulty breathing, dizziness, or widespread rash. If any of these symptoms occur, seek medical attention promptly.
It’s important to note that these measures are general recommendations and may not be suitable for all types of spider bites. If you suspect the bite is from a venomous spider or if you develop severe symptoms, such as muscle pain, abdominal pain, sweating, or difficulty breathing, seek immediate medical attention.
Preventing spider bites is the best approach. Take precautions such as wearing protective clothing, using insect screens, and avoiding areas where spiders are commonly found.
sprain vs break
Distinguishing between a broken bone (fracture) and a sprain can be challenging without medical imaging, but there are some signs and symptoms that can help differentiate between the two. Here are some indicators:
Broken Bone (Fracture):
1. Deformity: Visible deformity, such as a misalignment, angulation, or an abnormal shape of the affected area.
2. Intense pain: Severe and persistent pain, especially with movement or pressure on the area.
3. Swelling and bruising: Swelling that develops rapidly around the injured site, often accompanied by bruising.
4. Limited range of motion: Difficulty or inability to move the affected area normally.
5. Grating or popping sensation: Sometimes, a fracture may produce an audible or palpable sensation at the site of the injury.
6. Crepitus: A crunching or crackling sound or feeling when the broken ends of the bone rub against each other.
Sprain:
1. Swelling and bruising: Swelling that develops gradually around the injured joint or area, often accompanied by bruising.
2. Pain and tenderness: Pain that is localized to the injured joint or area, which may worsen with movement or pressure.
3. Limited range of motion: Difficulty moving the affected joint or area due to pain and swelling.
4. Instability: Feeling of joint instability or a sense that the joint is “giving way.”
5. Popping or tearing sensation: Sometimes, a sprain may be associated with a popping or tearing sensation at the time of injury.
It’s important to note that these are general guidelines, and the only way to definitively diagnose a fracture or sprain is through medical evaluation, which may involve physical examination, X-rays, or other imaging tests. If you suspect a broken bone or sprain, it is recommended to seek medical attention for proper diagnosis and appropriate treatment. Prompt medical evaluation is particularly important for suspected fractures to ensure proper alignment and healing.
Symptoms of Concussion
Symptoms of a concussion, a mild traumatic brain injury, can vary from person to person. Some common symptoms include:
- Headache or pressure in the head
- Dizziness or feeling off-balance
- Nausea or vomiting
- Sensitivity to light or noise
- Blurred vision or double vision
- Confusion or feeling foggy
- Memory problems or difficulty concentrating
- Fatigue or feeling tired
- Sleep disturbances (sleeping more or less than usual)
- Mood changes, irritability, or anxiety
- Slurred speech
- Ringing in the ears (tinnitus)
If you suspect a concussion, it’s important to seek medical attention. A healthcare professional can evaluate your symptoms and provide appropriate treatment recommendations. In general, the treatment for a concussion involves the following:
SLEEP IS GOOD!
- Rest: Rest is crucial for allowing the brain to heal. Physical and mental rest may be recommended, which may include avoiding physical exertion, reducing screen time, and limiting activities that can worsen symptoms.
- Medications: Over-the-counter pain relievers, such as acetaminophen, may be recommended for headaches. However, it’s important to consult a healthcare professional before taking any medications, as some medications can increase the risk of bleeding or interact with other treatments.
- Cognitive and physical rest: Activities that require concentration and physical exertion should be gradually reintroduced as symptoms improve. It’s important to follow the guidance of a healthcare professional to prevent worsening of symptoms.
- Symptom management: Specific symptoms, such as headaches or sleep disturbances, may be addressed individually with appropriate interventions and strategies.
- Monitoring: Regular follow-up appointments may be scheduled to monitor your progress and ensure that symptoms are improving. If symptoms worsen or new symptoms develop, it’s important to seek medical attention.
It’s important to note that every concussion is unique, and treatment recommendations may vary depending on the individual and the severity of the injury. Following medical advice and allowing adequate time for recovery is crucial for optimal healing and minimizing potential complications.
Tornado Prep
Preparing for tornadoes involves taking proactive steps to ensure your safety and minimize potential damage. Here are some important measures to consider:
- Stay informed: Stay updated on weather conditions by monitoring local news, weather apps, or a NOAA Weather Radio. Be aware of tornado watches (conditions are favorable for tornadoes) and tornado warnings (a tornado has been spotted or indicated by radar).
- Develop an emergency plan: Create a detailed plan with your household members to know what to do in case of a tornado. Identify a safe shelter location within your home, such as a basement, storm cellar, or an interior room on the lowest level without windows. Discuss the plan with everyone and practice tornado drills regularly.
- Prepare an emergency kit: Assemble an emergency kit with essential supplies that can sustain you and your family for at least 72 hours. Include items such as non-perishable food, water, medications, a flashlight, batteries, a first aid kit, a battery-powered weather radio, a whistle, cash, and important documents.
- Secure your home: Reinforce your home’s structural integrity by ensuring it is well-maintained. Secure loose objects outside, such as patio furniture, that could become dangerous projectiles in high winds. Consider installing impact-resistant windows or shutters, and reinforce garage doors to withstand strong winds.
- Create a communication plan: Establish a communication plan with your family and friends, designating an out-of-area contact person. This person can serve as a central point of contact to relay information and check on each other’s safety during and after the tornado.
- Stay aware of warning signs: Learn to recognize the signs of an approaching tornado, such as dark, greenish skies; a rotating, funnel-shaped cloud; a loud, continuous roar similar to a freight train; or debris being lifted into the air. If you observe any of these signs, take immediate action to seek shelter.
- Stay tuned to alerts: Listen to local authorities and follow their instructions during tornado warnings. Take shelter immediately if a tornado warning is issued for your area.
- Practice situational awareness: Be observant of your surroundings and the weather conditions. If you see a tornado or its funnel cloud, take cover immediately.
- Have a plan for community shelters: Familiarize yourself with community tornado shelters or safe locations, such as designated storm shelters, schools, or public buildings. Identify their locations in advance and know how to access them if necessary.
- Review and update your insurance: Review your homeowner’s insurance policy to ensure you have adequate coverage for tornado damage. Consider adding coverage for specific hazards, such as wind or hail, if necessary.
Remember, tornadoes can be unpredictable and develop quickly. It’s crucial to stay vigilant, have a plan in place, and take immediate action to protect yourself and your loved ones when a tornado threat arises.
altitude Sickness
Altitude sickness, also known as acute mountain sickness (AMS), can occur when traveling to high-altitude locations where the air pressure is lower and the oxygen levels are reduced. Here are the symptoms of altitude sickness and some home remedies that may help alleviate mild symptoms:
Symptoms of Altitude Sickness (Acute Mountain Sickness):
- Headache (usually the primary symptom)
- Fatigue or weakness
- Dizziness or lightheadedness
- Nausea or vomiting
- Loss of appetite
- Shortness of breath
- Difficulty sleeping
- Rapid heartbeat
- Swelling of the hands, feet, or face (in severe cases)
Home Remedies for Altitude Sickness (Mild Symptoms):
1. Rest and acclimatize: Allow your body time to adjust to the high altitude by taking it easy and avoiding strenuous activities for the first day or two. Gradually increase your activity level as your body adjusts.
- Stay hydrated: Drink plenty of fluids, preferably water, to stay hydrated. Avoid excessive caffeine and alcohol consumption, as they can contribute to dehydration.
- Avoid overexertion: Pace yourself and avoid pushing your physical limits. Listen to your body and rest when needed.
- Eat light meals: Consume smaller, more frequent meals that are easy to digest. Avoid heavy, greasy foods that can contribute to nausea or digestive discomfort.
- Use over-the-counter medications: Non-prescription pain relievers, such as acetaminophen or ibuprofen, may help alleviate headaches or body aches associated with altitude sickness. However, consult with a healthcare professional before taking any medication, especially if you have underlying medical conditions or take other medications.
- Drink coca tea or chew coca leaves (where legal): Coca tea or leaves, commonly used in some high-altitude regions, are believed to have mild stimulant effects and may help alleviate symptoms of altitude sickness for some individuals. However, it’s important to respect local laws and regulations regarding the use of coca products.
While these home remedies may provide some relief for mild altitude sickness symptoms, it’s important to note that severe or worsening symptoms should not be ignored. If symptoms become severe or if you experience symptoms of high-altitude pulmonary edema (HAPE) or high-altitude cerebral edema (HACE), which are more serious conditions, it is crucial to seek immediate medical attention.
Additionally, if you know you will be traveling to high altitudes and are concerned about altitude sickness, consider discussing preventive medications, such as acetazolamide (Diamox), with a healthcare professional. These medications can help prevent or reduce the severity of altitude sickness symptoms, but they require a prescription and should be used under medical supervision.
Remember, the best way to prevent altitude sickness is to ascend to high altitudes gradually, allowing your body time to acclimate. If you have concerns or a history of severe altitude sickness, consult with a healthcare professional before traveling to high-altitude destinations.
Diabetes and treatments
Diabetes is a chronic condition characterized by high blood sugar levels due to either inadequate insulin production (Type 1 diabetes) or the body’s inability to effectively use insulin (Type 2 diabetes). The symptoms and treatment options for diabetes differ based on the type of diabetes:
Type 1 Diabetes:
Symptoms:
1. Frequent urination
2. Excessive thirst
3. Unexplained weight loss
4. Increased hunger
5. Fatigue and weakness
6. Blurred vision
7. Slow healing of wounds
8. Frequent infections
Treatment:
1. Insulin therapy: People with Type 1 diabetes require lifelong insulin therapy. Insulin is administered through injections or an insulin pump to regulate blood sugar levels.
2. Blood sugar monitoring: Regular monitoring of blood sugar levels helps in determining the appropriate insulin dosage.
3. Healthy diet: Following a balanced diet that includes carbohydrate counting and portion control is important to manage blood sugar levels.
4. Regular exercise: Engaging in regular physical activity can help control blood sugar levels and improve overall health.
5. Education and support: Diabetes education and support groups can provide guidance on managing the condition and coping with the challenges associated with Type 1 diabetes.
Type 2 Diabetes:
Symptoms:
1. Frequent urination
2. Excessive thirst
3. Increased hunger
4. Fatigue and weakness
5. Blurred vision
6. Slow healing of wounds
7. Recurring infections, such as urinary tract infections
Treatment:
1. Lifestyle changes: Making healthy lifestyle modifications such as adopting a balanced diet, engaging in regular physical activity, maintaining a healthy weight, and managing stress can help control blood sugar levels.
2. Oral medications: In some cases, oral medications may be prescribed to help lower blood sugar levels and improve insulin sensitivity.
3. Insulin therapy: If lifestyle changes and oral medications are insufficient, insulin therapy may be required to manage blood sugar levels effectively.
4. Blood sugar monitoring: Regular monitoring of blood sugar levels is important to track progress and adjust treatment accordingly.
5. Education and support: Diabetes education programs and support groups can provide valuable information and guidance on managing Type 2 diabetes effectively.
It is important for individuals with diabetes to work closely with their healthcare provider to develop a personalized treatment plan that addresses their specific needs and goals. Regular medical check-ups, blood tests, and ongoing management are crucial for successfully managing diabetes and preventing complications.
Poison Ivy, Oak and Sumac treatment
While there are various folk remedies that people claim to be effective for treating poison ivy, poison sumac, and poison oak, it’s important to note that scientific evidence supporting their efficacy is limited. It’s always advisable to consult with a healthcare professional for appropriate treatment. However, here are a few folk remedies that some individuals have reported to provide relief:
- Cold compress: Applying a cold compress or ice pack to the affected area can help reduce itching and inflammation. Wrap the ice pack in a thin cloth to prevent direct contact with the skin and apply it for short intervals at a time.
- Oatmeal baths: Taking a bath with colloidal oatmeal can help soothe itching and provide temporary relief. You can find colloidal oatmeal in many drugstores, or you can grind regular oats into a fine powder and add it to your bathwater.
- Baking soda paste: Mixing baking soda with water to create a paste and applying it to the affected area may help alleviate itching and dry out the blisters. Leave the paste on for a few minutes before rinsing it off.
- Aloe vera gel: The cooling and soothing properties of aloe vera gel may provide temporary relief from itching and inflammation. Apply a thin layer of pure aloe vera gel to the affected area as needed.
- Witch hazel: Witch hazel is a natural astringent that may help relieve itching and dry out blisters. Apply witch hazel to a cotton ball and gently dab it onto the affected skin.
- Jewelweed: Some people believe that jewelweed, a plant commonly found in the same areas as poison ivy, poison sumac, and poison oak, can provide relief. Crushing the plant and applying the juice or using jewelweed soap or lotion may help alleviate itching. However, scientific evidence supporting its effectiveness is lacking.
It’s important to note that these remedies may provide temporary relief from symptoms but may not effectively treat the underlying allergic reaction. If you have a severe reaction or if the rash covers a large area, it’s best to seek medical advice for proper diagnosis and treatment. Additionally, avoid scratching the affected area to prevent further irritation and the potential for infection.
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