Foot infection is a major reason for hospitalization among patients with diabetes and also an important causal factor for lower limb amputation. There are various presentations of diabetic foot infections as well as several ways to classify these entities.
Preventation of Diabetic foot Infection
Diabetic foot infection is prevente by frequent chiropody review, good foot hygiene, diabetics socks and shoes, and avoiding injury.
a. Foot-care education combined with increased surveillance can reduce the incidence of serious foot lesions.
b. Footwear. Special footwears are recommended for patients with a prior ulcer or with foot deformities. One review added neuropathy as an indication for special footwear. The comparison of custom shoes versus well-chosen and well-fitted athletic shoes is not clear. A meta-analysis by the Cochrane Collaboration concluded that "there is very limited evidence of the effectiveness of therapeutic shoes" . The date of the literature search for this review is not clear. Clinical Evidence reviewed the topic and concluded "Individuals with significant foot deformities should be considered for referral and assessment for customised shoes that can accommodate the altered foot anatomy. In the absence of significant deformities, high quality well fitting non-prescription footwear seems to be a reasonable option" . National Institute for Health and Clinical Excellence has reviewed the topic and concluded that for patients at "high risk of foot ulcers (neuropathy or absent pulses plus deformity or skin changes or previous ulcer" that "specialist footwear and insoles" should be provided.
Treatment of Diabetic Foot Infections
Diabetic foot infections should be managed with a multidisciplinary team approach utilizing appropriate consultations. Hospitalization of patients with limb-threatening infections is mandatory. All diabetic foot infections must be monitored closely. Equally important for the best possible outcome are patient compliance and education, especially in outcome management.
You can visit internal medicine residency teaching for more details on diagnosis, symptoms and treatment of patient for the students and nurses.
Wednesday, March 17, 2010
Wednesday, February 3, 2010
Cardiology Teaching
Cardiology is medical speciality dealing with disorders of the heart and blood vessels. The course module of cardiology teaching includes diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular heart disease and electrophysiology. This internal medicine curriculum package has been designed for students & nurses who know nothing at all about Cardiology. Physicians specializing in this field of medicine are called cardiologists. Cardiologists should not be confused with cardiac surgeons, cardiothoracic and cardiovascular, who are surgeons who perform cardiac surgery - operative procedures on the heart and great vessels.
Wednesday, January 6, 2010
Acute Asthma Management
There have been many victims of acute asthma attack and the result of these attacks can be frightening. It is a chronic disease. Many People suffers from Asthma around the world. Due to inflamed and narrow airways respiratory impairment occurs. There is bronchial constriction and mucus may also cause further discomfort. The body is unable to refresh the air sacs in the lungs which may cause distress. The patients undergo from shortness of respite and may also have wheezing. A person is said to undergo from an acute asthma attack when the symptoms flare up necessitating medical intervention most of the time.
Symptoms Of Acute Asthma Attack
• rapid breathing
• physical exhaustion
• difficulty in talking
• wheezing (which is quiet)
• coughing
• marked recession
• paradoxical pulse where the pulse is strong during expiration and weak during inhalation
• constriction and pain in the chest
• turning blue due to lack of oxygen
• lack of consciousness
• numbness in limbs
• sweating of the palms
• feet may turn icy
• peak respiratory flow is less than 50% of the mean value
These patients can avoid acute asthma attack by paying attention to the signs and symptoms that indicate that their condition is not improving. Many people have made the mistake of neglecting to get medical aid as the wheezing and the gulping appears to have got better. If this occurs with lips turning blue and lack of consciousness, the condition is very serious demanding immediate medical intervention in order to avoid death.
People suffering from asthma may prevent acute attacks by making sure they take the necessary medication to prevent the situation from aggravating. They can make use of a peak flow meter to monitor their condition. It is required that they get their baseline measurement by inhaling and then exhaling into the meter when they are feeling fit. If their peak flow measurement is 50%-80% lesser than their baseline peak flow measurement, it may indicate they are at risk of an acute asthma attack if they do not take immediate action. If the peak flow reading is lesser than 50% of their normal reading it is time they sought medical intervention as a severe attack can become life threatening in some cases.
It will help if patients carry a card or wear a medical alert bracelet that can be useful if medical intervention is needed. The patients need to have worked out a plan on what has to be done during an attack. The patients may also keep a card with the name of their physician, his number as well as the number of an ambulance, and the relative or friend who has to be contacted. If the inhaled reliever is not working, it is time you sought immediate medical help. Make it a point to inform them that you have an acute asthma attack and are not responding to treatment. Till help arrives continue to use the reliever taking 6-8 puffs every 5-6 minutes. Make sure to use a spacer as it will be of great help. The best way to manage asthma and to prevent an acute asthma attack is to monitor the symptoms, take medication promptly and ensure that the condition does not get aggravated.
For powerful, useful and unique information on asthma for student of internal medicine curriculum please visit to http://professorebm.com
Symptoms Of Acute Asthma Attack
• rapid breathing
• physical exhaustion
• difficulty in talking
• wheezing (which is quiet)
• coughing
• marked recession
• paradoxical pulse where the pulse is strong during expiration and weak during inhalation
• constriction and pain in the chest
• turning blue due to lack of oxygen
• lack of consciousness
• numbness in limbs
• sweating of the palms
• feet may turn icy
• peak respiratory flow is less than 50% of the mean value
These patients can avoid acute asthma attack by paying attention to the signs and symptoms that indicate that their condition is not improving. Many people have made the mistake of neglecting to get medical aid as the wheezing and the gulping appears to have got better. If this occurs with lips turning blue and lack of consciousness, the condition is very serious demanding immediate medical intervention in order to avoid death.
People suffering from asthma may prevent acute attacks by making sure they take the necessary medication to prevent the situation from aggravating. They can make use of a peak flow meter to monitor their condition. It is required that they get their baseline measurement by inhaling and then exhaling into the meter when they are feeling fit. If their peak flow measurement is 50%-80% lesser than their baseline peak flow measurement, it may indicate they are at risk of an acute asthma attack if they do not take immediate action. If the peak flow reading is lesser than 50% of their normal reading it is time they sought medical intervention as a severe attack can become life threatening in some cases.
It will help if patients carry a card or wear a medical alert bracelet that can be useful if medical intervention is needed. The patients need to have worked out a plan on what has to be done during an attack. The patients may also keep a card with the name of their physician, his number as well as the number of an ambulance, and the relative or friend who has to be contacted. If the inhaled reliever is not working, it is time you sought immediate medical help. Make it a point to inform them that you have an acute asthma attack and are not responding to treatment. Till help arrives continue to use the reliever taking 6-8 puffs every 5-6 minutes. Make sure to use a spacer as it will be of great help. The best way to manage asthma and to prevent an acute asthma attack is to monitor the symptoms, take medication promptly and ensure that the condition does not get aggravated.
For powerful, useful and unique information on asthma for student of internal medicine curriculum please visit to http://professorebm.com
Wednesday, December 23, 2009
Causes of Chest Pain
Chest pain is discomfort or pain that you feel anywhere along the front of your body between your neck and upper abdomen. It is also known as chest tightness, chest pressure, chest discomfort. When people feel chest pains they automatically fear something wrong with the heart. People are terrified by the idea of having a heart attack because they are so dangerous and they kill so many people every year. However, there are many possible causes of chest pain. Some causes are mildly inconvenient, while other causes are serious, even life-threatening. Any organ or tissue in your chest can be the source of pain, including your heart, lungs, esophagus, muscles, ribs, tendons, or nerves.
Some Common Causes of Chest Pain
1. The pain which occurs due to heart is not getting enough blood and oxygen is called Angina. The most common symptom is chest pain that occurs behind the breast bone or slightly to the left of it. It may feel like tightness, heavy pressure, squeezing, or crushing pain. The pain may spread to the arm, shoulder, jaw, or back.
2. Heart attack pain can be similar to the pain of unstable angina, but more severe.
3. Aortic dissection causes sudden & severe pain in the chest and upper back.
4. Inflammation or infection in the tissue around the heart causes pain in the center part of the chest.
5. Pneumonia, which causes chest pain that usually feels sharp, and often gets worse when you take a deep breath or cough
6. A blood clot in the lung (pulmonary embolism), collapse of a small area of the lung (pneumothorax), or inflammation of the lining around the lung (pleurisy) can cause chest pain that usually feels sharp, and often gets worse when you take a deep breath or cough
7. Asthma, which generally also causes shortness of breath, wheezing, or coughing
8. Strain or inflammation of the muscles and tendons between the ribs
9. Inflammation where the ribs join the breast bone or sternum (costochondritis)
10. Shingles (sharp, tingling pain on one side that stretches from the chest to the back)
11. Anxiety and rapid breathing
12. Heartburn or gastroesophageal reflux (GERD)
13. Stomach ulcer (burning pain occurs if your stomach is empty and feels better when you eat food)
14. Gallbladder (pain often gets worse after a meal, especially a fatty meal)
For getting inpatient medicine curriculum study material on chest pain please visit professorebm.
Some Common Causes of Chest Pain
1. The pain which occurs due to heart is not getting enough blood and oxygen is called Angina. The most common symptom is chest pain that occurs behind the breast bone or slightly to the left of it. It may feel like tightness, heavy pressure, squeezing, or crushing pain. The pain may spread to the arm, shoulder, jaw, or back.
2. Heart attack pain can be similar to the pain of unstable angina, but more severe.
3. Aortic dissection causes sudden & severe pain in the chest and upper back.
4. Inflammation or infection in the tissue around the heart causes pain in the center part of the chest.
5. Pneumonia, which causes chest pain that usually feels sharp, and often gets worse when you take a deep breath or cough
6. A blood clot in the lung (pulmonary embolism), collapse of a small area of the lung (pneumothorax), or inflammation of the lining around the lung (pleurisy) can cause chest pain that usually feels sharp, and often gets worse when you take a deep breath or cough
7. Asthma, which generally also causes shortness of breath, wheezing, or coughing
8. Strain or inflammation of the muscles and tendons between the ribs
9. Inflammation where the ribs join the breast bone or sternum (costochondritis)
10. Shingles (sharp, tingling pain on one side that stretches from the chest to the back)
11. Anxiety and rapid breathing
12. Heartburn or gastroesophageal reflux (GERD)
13. Stomach ulcer (burning pain occurs if your stomach is empty and feels better when you eat food)
14. Gallbladder (pain often gets worse after a meal, especially a fatty meal)
For getting inpatient medicine curriculum study material on chest pain please visit professorebm.
Wednesday, December 16, 2009
Acid Base Disorders
Body pH plays a vital role in maintenance of your body’ many intricate systems. pH scale is used to measure Acidity & Alkalinity of your body. Any element with a pH below 7.0 is acid, while any substance with a above 7.0 is alkaline. The ideal pH range for the human body is between 6.0 and 6.8 which is slightly acid. Body with pH 6.3 is considered on the acidic side & pH above 6.8 is considered on the alkaline side.
You can take pH test to determine your own body pH. This test will determine whether your body fluids are either too acidic or too alkaline. Always perform the test either before you eat or at least one hour after eating. If your test indicates that your body is too acidic, consult the recommendations for Acidosis.
In Acid Base Disorder body chemistry is imbalanced and overly acidic. Symptoms of acid base disorder (acidosis) include frequent sighting, insomnia, water retention, recessed eyes, arthritis, migraine headache, abnormally low blood pressure, acid or strong perspiration, dry hard stools, foul smelling stools accompanied by a burning sensation in the anus, alternating constipation and diarrhea, difficulty swallowing, halitosis, a burning sensation in the mouth and / or under the tongue, sensitivity of the teeth to vinegar and acidic fruits, and bumps on the tongue or the roof of the mouth.
There are two classifications of acidosis: respiratory and metabolic
1. Respiratory acidosis is caused by an interruption of the acid control of the body and results in an overabundance of acidic fluids or the depletion of alkali. Simply put, it occurs if the lungs are unable to remove carbon dioxide. Respiratory acidosis can be a result of asthma, bronchitis, or obstruction of the airway. It can be mild or severe.
2. Metabolic acidosis is caused by chemical changes in the body which disturb the acid-base balance. This results in an excessive amount of acid in the body fluids. Diabetes mellitus, kidney failure, the use of unusually large amounts of aspirin and metabolic diseases are some of the conditions that can deplete the body's alkaline base. Other contributing factors can include liver and adrenal disorders, stomach ulcers, improper diet, malnutrition, obesity, ketosis, anger, stress, fear, anorexia, toxemia, fever and the consumption of excessive amounts of niacin and vitamin C.
To get full curriculum on Practical Approach to Acid-Base Disorders visit Professor EBM & get study material on internal medicine curriculum
You can take pH test to determine your own body pH. This test will determine whether your body fluids are either too acidic or too alkaline. Always perform the test either before you eat or at least one hour after eating. If your test indicates that your body is too acidic, consult the recommendations for Acidosis.
In Acid Base Disorder body chemistry is imbalanced and overly acidic. Symptoms of acid base disorder (acidosis) include frequent sighting, insomnia, water retention, recessed eyes, arthritis, migraine headache, abnormally low blood pressure, acid or strong perspiration, dry hard stools, foul smelling stools accompanied by a burning sensation in the anus, alternating constipation and diarrhea, difficulty swallowing, halitosis, a burning sensation in the mouth and / or under the tongue, sensitivity of the teeth to vinegar and acidic fruits, and bumps on the tongue or the roof of the mouth.
There are two classifications of acidosis: respiratory and metabolic
1. Respiratory acidosis is caused by an interruption of the acid control of the body and results in an overabundance of acidic fluids or the depletion of alkali. Simply put, it occurs if the lungs are unable to remove carbon dioxide. Respiratory acidosis can be a result of asthma, bronchitis, or obstruction of the airway. It can be mild or severe.
2. Metabolic acidosis is caused by chemical changes in the body which disturb the acid-base balance. This results in an excessive amount of acid in the body fluids. Diabetes mellitus, kidney failure, the use of unusually large amounts of aspirin and metabolic diseases are some of the conditions that can deplete the body's alkaline base. Other contributing factors can include liver and adrenal disorders, stomach ulcers, improper diet, malnutrition, obesity, ketosis, anger, stress, fear, anorexia, toxemia, fever and the consumption of excessive amounts of niacin and vitamin C.
To get full curriculum on Practical Approach to Acid-Base Disorders visit Professor EBM & get study material on internal medicine curriculum
Thursday, December 10, 2009
What is Acute Respiratory Distress Syndrome?
Acute Respiratory Distress Syndrome
It is originally described in adults, acute respiratory distress syndrome (ARDS) occurs in children of all ages; hence, it change from "adult" to "acute" respiratory distress syndrome. The syndromes of acute lung injury (ALI) and ARDS usually do not manifest in the typical time frame for emergency department (ED) treatment. However, effective early recognition and treatment of bacteremia, shock, and respiratory failure may prevent the cascade of host responses that result in ARDS as well as comorbidities.
Recognizing that patients who have been resuscitated from circulatory failure may have a period of relative stability followed by deterioration secondary to ARDS or other components of the multiple organ failure syndrome (MOFS) is important. This recognition should allow informed decision making of the need for transport or ongoing critical care.
History
Histories at the time of initial presentation offer little with regards to diagnosis of ALI/ARDS except for alerting the clinician to risks for development of lung injury such as exposure to gaseous fumes or hydrocarbon ingestion and potential aspiration. The time to develop hypoxemia severe enough for ALI/ARDS criteria is also dependent on the time of onset of the triggering disease or injury. ALI/ARDS may further be masked by preexisting medical problems including reactive airway disease and bronchopulmonary dysplasia. Exacerbation of such underlying chronic lung diseases can lead to severe wheezing as the chief complaint.
• Establishing ALI/ARDS criteria is highly variable and is dependent of the onset of illness/insult.
• In most patients, ARDS developed within 72 hours after the onset of the associated acute disease and many (42%) within 24 hours.
• In those with infectious pneumonia, the onset is often gradual.
Get here detailed EBM curriculum
Causes
• ARDS is a clinical syndrome for which no specific marker exists. However, several have been identified to be associated with ARDS including tumor necrosis factor- (TNF-), interleukin- (IL-), interleukin 10 (IL-10), and more recently, soluble intercellular adhesion molecule 1 (sICAM-1). One of the most common diseases associated with ARDS is sepsis and/or septic shock. Other more common etiologies include infectious pneumonia, aspiration pneumonia, aspiration of gastric contents and other noxious substances (eg, hydrocarbons), inhalational injury (eg, thermal injury, noxious gases), and barotrauma/volutrauma secondary to mechanical ventilation.
• Failure of other organ systems commonly results in ARDS.
• Most near-drowning victims aspirate at least some water. Both fresh and saltwater aspiration results in pulmonary edema. If near-drowning occurs in stagnant or contaminated water, the risk of bacterial pneumonia is high. However, neither corticosteroids nor prophylactic antibiotics are beneficial.
It is originally described in adults, acute respiratory distress syndrome (ARDS) occurs in children of all ages; hence, it change from "adult" to "acute" respiratory distress syndrome. The syndromes of acute lung injury (ALI) and ARDS usually do not manifest in the typical time frame for emergency department (ED) treatment. However, effective early recognition and treatment of bacteremia, shock, and respiratory failure may prevent the cascade of host responses that result in ARDS as well as comorbidities.
Recognizing that patients who have been resuscitated from circulatory failure may have a period of relative stability followed by deterioration secondary to ARDS or other components of the multiple organ failure syndrome (MOFS) is important. This recognition should allow informed decision making of the need for transport or ongoing critical care.
History
Histories at the time of initial presentation offer little with regards to diagnosis of ALI/ARDS except for alerting the clinician to risks for development of lung injury such as exposure to gaseous fumes or hydrocarbon ingestion and potential aspiration. The time to develop hypoxemia severe enough for ALI/ARDS criteria is also dependent on the time of onset of the triggering disease or injury. ALI/ARDS may further be masked by preexisting medical problems including reactive airway disease and bronchopulmonary dysplasia. Exacerbation of such underlying chronic lung diseases can lead to severe wheezing as the chief complaint.
• Establishing ALI/ARDS criteria is highly variable and is dependent of the onset of illness/insult.
• In most patients, ARDS developed within 72 hours after the onset of the associated acute disease and many (42%) within 24 hours.
• In those with infectious pneumonia, the onset is often gradual.
Get here detailed EBM curriculum
Causes
• ARDS is a clinical syndrome for which no specific marker exists. However, several have been identified to be associated with ARDS including tumor necrosis factor- (TNF-), interleukin- (IL-), interleukin 10 (IL-10), and more recently, soluble intercellular adhesion molecule 1 (sICAM-1). One of the most common diseases associated with ARDS is sepsis and/or septic shock. Other more common etiologies include infectious pneumonia, aspiration pneumonia, aspiration of gastric contents and other noxious substances (eg, hydrocarbons), inhalational injury (eg, thermal injury, noxious gases), and barotrauma/volutrauma secondary to mechanical ventilation.
• Failure of other organ systems commonly results in ARDS.
• Most near-drowning victims aspirate at least some water. Both fresh and saltwater aspiration results in pulmonary edema. If near-drowning occurs in stagnant or contaminated water, the risk of bacterial pneumonia is high. However, neither corticosteroids nor prophylactic antibiotics are beneficial.
Friday, December 4, 2009
Acetaminophen Toxicity
Acetaminophen is one of the most common medicine given to children. It is also known as paracetamol and N -acetyl-p-aminophenol (APAP). The medicine is commonly given to cure fever and pain. Yet, for parents, it can be one of the most challenging medicine to provide a dosage correctly. This is because it is easily available in many forms. It has become a staple resident of home medicine cabinets in one form or the other. Due to its easy availability, it is considered to be the medicine that causes most deaths due to overdose. Overdoses occur because parents are unaware of Acetaminophen's toxicity. Symptoms of acetaminophen intoxication include nausea and vomiting, abdominal pain, and liver failure.
There are few things that parents should remember before giving Acetaminophen to their children.
• Never provide Acetaminophen to a child under the age of 3 months without consulting your doctor.
• The amount of Acetaminophen given to a child depends on his weight and not on his age.
• Read the medications label carefully as it is easy to be confused by the different forms and concentration of acetaminophen that is available at the medical store
• Remember to use the measuring device that came with the medication to ensure correct amount of dosage.
• Check whether you are giving an adult dosage or a child's dosage before giving the medicine. Even within the children's version there are many variations depending on age group. For example, an infant modify formulation is three times as concentrated as the syrup given to toddlers.
• Overdose of acetaminophen can cause liver damage.
internal medicine curriculum,
Medicine Residency Programs
There are few things that parents should remember before giving Acetaminophen to their children.
• Never provide Acetaminophen to a child under the age of 3 months without consulting your doctor.
• The amount of Acetaminophen given to a child depends on his weight and not on his age.
• Read the medications label carefully as it is easy to be confused by the different forms and concentration of acetaminophen that is available at the medical store
• Remember to use the measuring device that came with the medication to ensure correct amount of dosage.
• Check whether you are giving an adult dosage or a child's dosage before giving the medicine. Even within the children's version there are many variations depending on age group. For example, an infant modify formulation is three times as concentrated as the syrup given to toddlers.
• Overdose of acetaminophen can cause liver damage.
internal medicine curriculum,
Medicine Residency Programs
Subscribe to:
Posts (Atom)