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)

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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.

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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.

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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.

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

Blood Transfusion

When a person is given a blood transfusion, that person is really only receiving part of the blood that has been donated for his or her use. The transfusions typically transfuse only the red blood cells that have been donated.

Blood transfusions are used to correct two main, major types of problems. The first problem is acute and massive blood loss. This empties the blood vessels to the degree that the heart cannot maintain enough blood pressure to move the blood through the body. The second problem is severe anemia. Severe anemia is when there is enough blood volume in the body but not enough red blood cells in the blood to get oxygen to the body's tissues.

Physicians have to carry out compatibility test before blood transfusion to their patient. Cross-Matching, is a test done by physicians to determine if the donated blood matches the recipient's blood that is in dire need of a blood transfusion. There are two ways to do cross-match test: Electronic and Manual.

Electronic Cross-Matching: You simply inject the donor's blood and the recipient's blood into a machine which connects to a computer. If all the necessary components of the blood are compatible, the computer prints off a sheet that tells you that it is safe to do a transfusion with this blood. The physician can then safely perform the transfusion of the blood. This is an important factor during emergencies when a patient has lost a lot of blood.

Serological Cross-Matching: When the electronic method is not available, serological cross-matching is the second choice. In this method, the physician or the blood technician at hand has to manually do the test in order to verify whether the blood of the recipient matches the blood of the donor. Blood is collected from the recipient. Plasma from the blood is extracted via centrifuge method. The plasma is then injected with a syringe into test tubes with the donor blood. If agglutination occurs, then that means that the patient's plasma contains antibodies against the donor's blood. If there is no agglutination, then a match is made and the blood is safe to transfuse.

For getting more details & case studies of blood transfusion, read internal medicine teaching by Professor EBM.

Internal Medical Training Program through Distance Learning

There are many educational programs that are offered through distance learning. Whether you are interested in obtaining a particular level of certification or accreditation, or if you just want to gain a certain amount of knowledge about an area of study that is of interest to you, distance learning programs might be the answer for you.

A goal of internal medicine training programs is to provide trainees with supervised clinical experiences in preparation for their future professional careers. For getting Study Material Visit Professor EBM, the premier online, evidence-based teaching resource for inpatient internal medicine.

It is composed of over 80 teaching modules designed for use in internal medicine residency programs and student clerkships. Each topic is meticulously researched, footnoted and updated on a yearly basis. Major, influential studies are identified, summarized and analyzed. In diseases in which the evidence is sparse, relevant review articles, guidelines and systematic reviews are noted. All cases, questions, answers and summaries of original articles are developed using the principles of evidence-based medicine. The teaching modules are piloted in a real-life internal medicine residency program, and improvements are made based upon formal feedback from attendings and housestaff. The modules are designed to be taught in a small group, interactive format.

Evidence-based Medicine (EBM)

The Medical Center Library was asked to develop a plan for teaching EBM through the 4 years of Medical School. This document reflects the development of an EBM "thread" that builds on skills throughout the 4 years. The Library's role is coordinator, instructor, website builder, and facilitator.

Evidence-based Medicine (EBM) combines individual clinical expertise with the best available clinical evidence from systematic research in making decisions about the care of individual patients. Clinical expertise is the proficiency and judgment that individual clinicians acquire through clinical experience and practice. Clinical evidence comes from patient centered clinical research which investigates the accuracy and precision of diagnostic tests, the efficacy and safety of therapeutic regimes, and the reliability of prognostic indicators. The powerful combination of clinical expertise and documented evidence results in safer, more efficacious and accurate care of the patient.

Gastroenterology – Introduction

Diseases affecting the gastrointestinal tract, which includes the organs from mouth to anus, along the alimentary canal, are the focus of this specialty. Physicians practicing in this field of medicine are called gastroenterologists.

Bacterial gastroenteritis is a very common disorder. It has many causes, can range from mild to severe, and usually manifests with symptoms of vomiting, diarrhea, and abdominal discomfort. Other causes of some of these symptoms include viral infections, improper diet, malabsorption syndromes, various enteropathies, and inflammatory bowel disease.

Bacterial gastroenteritis is usually self-limited, but improper management of an acute infection can lead to a protracted course. By far, the most common complication is dehydration.

Medicine and Cardiology Teaching

"Medicine" is also often used amongst medical professionals as shorthand for internal medicine teaching. Veterinary medicine is the practice of health care in animal species other than human beings.

The practice of medicine combines both science and art. Science and technology is the evidence base for many clinical problems for the general population at large. The art of medicine is the application of this medical knowledge in combination with intuition and clinical judgment to determine the proper diagnoses and treatment plan for each unique patient and to treat the patient accordingly.

The division of cardiology teaching carries an ambitious academic and service mission. Among principles objectives are enhancing its development prospects and uplifting the quality, standard of the clinical services.

The traditional mode of operation of the cardiology services has revolved around in patient tertiary care, the rapidly changing technology and evolving practice trends in the country warrant considerable modification of the existing pattern of action

Internal Medicine Residency Education

Internal medicine residency education has evolved from providing exposures to meet objectives and measuring competencies. The internal medicine curriculum is designed to educate internal medicine residents to deliver compassionate, evidence-based medicine curriculum, high-quality, cost-effective care to adults and adolescents. Adult learning principles are encouraged and utilized including self-directed learning and tutorials.

It is Professor EBM goal to offer outstanding training for medical students, residents, fellows and practicing physicians. We provide an outstanding balance between hands-on clinical experience, didactic learning and exceptional quality of life.

Through a flexible curriculum structure, Internal Medicine residents are afforded the opportunity to focus their training in specific areas that are of most need in the medical community such as Hospitality Medicine.

Brief Introduction of Status Epilepticus (SE)

Status Epilepticus (SE) refers to a life-threatening condition in which the brain is in a state of persistent seizure. Definitions vary, but traditionally it is defined as one continuous unremitting seizure lasting longer than 30 minutes, or recurrent seizures without regaining consciousness between seizures for greater than 30 minutes (or shorter with medical intervention).

Subtle Status Epilepticus consists of electrical seizure activity that endures when the associated movements are fragmentary or even absent. This is confusing and is sometimes called a type of nonconvulsive Status Epilepticus.

Traditionally, Status Epilepticus was defined as 30 minutes of continuous seizure activity or a series of seizures without return to full consciousness between the seizures. Many believe that a shorter period of seizure activity causes neuronal injury and that seizure self-termination is unlikely after 5 minutes; some suggest times as brief as 5 minutes to define Status Epilepticus.

For detailed information on Status Epilepticus, read internal medicine teaching by Professor EBM.

An Introduction to Pleural effusion – Health Care

Pleural effusion is excess fluid that accumulates in the pleural cavity, the fluid-filled space that surrounds the lungs. Excessive amounts of such fluid can impair breathing by limiting the expansion of the lungs during inhalation.

Pleural effusion is defined as an abnormal accumulation of fluid in the pleural space. Excess fluid results from the disruption of the equilibrium that exists across pleural membranes.

Both parietal and visceral membranes are smooth, glistening, and semitransparent. Despite these similarities, the two membranes have unique differences in anatomic architecture, innervation, pain fibers, blood supply, lymphatic drainage, and function. For example, the visceral pleurae contain no pain fibers and have a dual blood supply (bronchial and pulmonary).

Normally, very small amounts of pleural fluid are present in the pleural spaces, and fluid is not detectable by routine methods. When certain disorders occur, excessive pleural fluid may accumulate and cause pulmonary signs and symptoms. Simply put, pleural effusions occur when the rate of fluid formation exceeds that of fluid absorption. Once a symptomatic, unexplained pleural effusion occurs, a diagnosis needs to be established.

Internal Medicine Teaching by Professor EBM is a complete medical solution.

Diastolic Heart Failure

The diagnosis of diastolic dysfunction is now fairly common, especially among older women, most of whom are shocked to hear they have a heart problem at all. While some of these patients will go on to develop actual diastolic heart failure, many will not - especially if they get appropriate medical care, and also take care of themselves.

The diagnosis of diastolic heart failure, unfortunately, is often missed by unwary physicians. Because once the patient presenting with diastolic heart failure has been stabilized, unless the doctor looks specifically for evidence of diastolic dysfunction on the echocardiogram, the heart can appear entirely "normal."

Diastolic heart failure, a major cause of morbidity and mortality, is defined as symptoms of heart failure in a patient with preserved left ventricular function. It is characterized by a stiff left ventricle with decreased compliance and impaired relaxation, which leads to increased end diastolic pressure.

Patients who have had an episode of diastolic heart failure have a somewhat better prognosis than patients with traditional, systolic heart failure - but a far worse prognosis than patients without heart failure or diastolic dysfunction. Given this relatively poor prognosis, patients should be aggressively evaluated and treated even after their acute episodes of heart failure have been resolved.

Diagnosis and Acute Management of Gout

Gout is a disease resulting from the deposition of urate crystals caused by the overproduction or under excretion of uric acid. The disease is often, but not always, associated with elevated serum uric acid levels. Clinical manifestations include acute and chronic arthritis, tophi, interstitial renal disease and uric acid nephrolithiasis. The diagnosis is based on the identification of uric acid crystals in joints, tissues or body fluids.

The diagnosis of gout is generally made on a clinical basis, although tests are required to confirm the disease. This is done by drawing fluid from the joint with a needle and examining it under a polarized light microscope. Although the test is invasive, the results are definitive, and a positive result facilitates proper treatment and quick relief. Usually, physicians can diagnose gout based on the physical examination and medical history (the patient's description of symptoms and other information). Doctors can also administer a test that measures the level of uric acid in the blood.

Cause of Gout
Gender and age are related to the risk of developing gout; it is more common in men than in women and more common in adults than in children.
Drinking too much alcohol can lead to hyperuricemia because it interferes with the removal of uric acid from the body.
An enzyme defect that interferes with the way the body breaks down purines causes gout in a small number of people, many of whom have a family history of gout.

Introduction to Diabetic ketoacidosis (DKA)

Diabetic ketoacidosis (DKA) is a potentially life-threatening complication in patients with diabetes mellitus. It happens predominantly in those with type 1 diabetes, but it can occur in those with type 2 diabetes under certain circumstances.

Diabetic ketoacidosis (DKA) is a state of inadequate insulin levels resulting in high blood sugar and accumulation of organic acids and ketones in the blood. It is also common in DKA to have severe dehydration and significant alterations of the body’s blood chemistry. Diabetic ketoacidosis (DKA) is a state of absolute or relative insulin deficiency aggravated by ensuing hyperglycemia, dehydration, and acidosis-producing derangements in intermediary metabolism. The most common causes are underlying infection, disruption of insulin treatment, and new onset of diabetes.

Diabetic ketoacidosis symptoms often develop quickly, sometimes within 24 hours. You may notice:

* Excessive thirst
* Frequent urination
* Nausea and vomiting
* Abdominal pain
* Loss of appetite
* Weakness or fatigue
* Shortness of breath
* Fruity-scented breath
* Confusion

How can it be detected?
* High blood sugar level
* High ketone level in your urine

Other possible triggers of diabetic ketoacidosis may include:

* Stress
* Physical or emotional trauma
* High fever
* Surgery
* Heart attack
* Stroke
* Alcohol or drug abuse

Diagnosis Of Ascites

Ascites is the presence of excess fluid in the peritoneal cavity. Ascites is more often associated with liver disease and other long-lasting (chronic) conditions. Ascites is excess fluid in the space between the tissues lining the abdomen and abdominal organs (the peritoneal cavity). Ascites occur in long-standing disorders including cirrhosis, alcoholic hepatitis without cirrhosis, chronic hepatitis, and obstruction of the hepatic vein. Several blood tests are commonly performed for ascites, including full blood count, electrolytes and renal function, liver enzymes, and glucose. If the cause is not apparent, serology for viruses known to cause hepatitis and ferritin may contribute to the analysis.

Ascites is the pathologic accumulation of fluid in the peritoneal cavity and is a common manifestation of liver failure, being one of the cardinal signs of portal hypertension. The diagnostic evaluation of ascites involves an assessment of its cause by determining the serum-ascites albumin gradient and the exclusion of complications e.g., spontaneous bacterial peritonitis. Although sodium restriction and diuretics remains the cornerstone of ascites management, many patients require additional therapy when they become refractory to such medical treatment. These include repeated large volume paracentesis and transjugular intrahepatic portosystemic shunts.

Small amounts of ascitic fluid cause no symptoms. Moderate amounts cause increased abdominal girth and weight gain. Massive amounts may cause nonspecific diffuse abdominal pressure, but actual pain is uncommon. If ascites results in elevation of the diaphragm, dyspnea may occur. Symptoms of SBP may include new abdominal discomfort and fever.
Professor EBM is a fantastic tool for focused, point-of-care teaching for attending rounds.

Alcoholic Hepatitis - Diagnosis & Symptoms

Alcoholic hepatitis is a syndrome of progressive inflammatory liver injury associated with long-term heavy intake of ethanol. The pathogenesis is not completely understood. Alcoholic hepatitis usually persists and progresses to cirrhosis if heavy alcohol use continues. If alcohol use ceases, alcoholic hepatitis resolves slowly over weeks to months, sometimes without permanent sequelae but often with residual cirrhosis.

Most patients with alcoholic hepatitis exhibit evidence of protein-energy malnutrition (PEM). In the past, nutritional deficiencies were assumed to play a major role in the development of liver injury. This assumption was supported by several animal models in which susceptibility to alcohol-induced cirrhosis could be produced by diets deficient in choline and methionine.

The following are the most common symptoms of alcoholic hepatitis. However, each individual may experience symptoms differently. Symptoms may include:

* abdominal tenderness
* spider-like blood vessels in the skin
* ascites - fluid build-up in the abdominal cavity.
* poor appetite
* jaundice - yellowing of the skin and eyes.
* low fever
* fatigue
* feeling ill

The symptoms of alcoholic hepatitis may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

How is Alcoholic Hepatitis diagnosed?
After completing mecia; history and physical examination, diagnosis procedure may include
1) Specific laboratory blood tests such as:

* Liver function studies
* bleeding times
* cellular blood counts
* tests for other chemicals in the body
* electrolyte tests

2)Ultrasound also known as Sonography

3)Liver Biopsy

Mission Of Professor EBM Curriculum

Evidence-based medicine (EBM) refers to the conscientious, explicit, and judicious use of the current best evidence in making decisions about the care of individual patients. The current advocacy of EBM derives from the growing evidence base supporting many clinical maneuvers, and the recognition of physicians unmet information needs, poor information retrieval skills, deterioration of up-to-date knowledge after training, and practice variations for interventions with established efficacy.

In particular, an EBM curriculum must include the acquisition, appraisal, and application of “the evidence” in the context of individual patient decision making. Many internal medicine programs are either initiating new EBM curriculum or transforming their traditional journal clubs. The objective of Professor EBM is to determine the prevalence and characteristics of EBM curriculum in internal medicine residency programs.

The mission of our program is to improve rural health care by developing excellent Family Physicians and advancing the discipline of Family Medicine in a setting which provides comprehensive medical care. Professor EBM is composed of 80 internal teaching medicine modules designed for use in internal medicine residency programs and student clerkship.

Introduction of Professor Evidence Based Medicine

Interest in evidence based medicine (EBM) has grown exponentially, and professional organizations and training programmers have shifted their agenda from whether to teach EBM to how to teach it. However, there is little evidence about the effectiveness of different methods, 1 and this may be related to the lack of a conceptual framework within which to structure evaluation strategies. In this article we propose a potential framework for evaluating methods of teaching EBM.

Professor EBM is a fantastic tool for focused, point-of-care teaching for attending rounds. Each teaching module focuses on one disease or topic encountered on the internal medicine wards. Each module is composed of two parts: a Learner’s Guide and a Teacher’s Guide. You can view sample learner's guide and sample teacher's guide. Each topic is meticulously researched, footnoted and updated on a yearly basis. Major, influential studies are identified, summarized and analyzed very efficiently. In diseases in which the evidence is sparse, relevant review articles, guidelines and systematic reviews are noted.

Evidence-based medicine is a broad concept. The broad aim of the group is to promote evidence based clinical practice of urology and to provide support and resources to anyone who wants to make use of them. Additionally we hope for the website to be used as a tool in educating fellow urologists in the principles of evidence based medicine as they apply to the specialty of urology.