Your Daily Meds

Share this post

Your Daily Meds - 8 December, 2022

yourdailymeds.substack.com

Your Daily Meds - 8 December, 2022

Luke Reynolds
Dec 7, 2022
Share
Share this post

Your Daily Meds - 8 December, 2022

yourdailymeds.substack.com

Good morning and welcome to your Thursday dose of Your Daily Meds.



Bonus Review: What are some delayed responses to major blood loss?

Answer: These are the responses that restore plasma volume, plasma proteins and red blood cells.

  • Plasma volume - returns to normal in 12-72 hours

  • Plasma protein synthesis - is increased in the liver; plasma protein levels may take a couple of days to return to normal

  • Increased red cell production - erythropoeitin levels increase to stimulate erythropoeisis; reticulocyte levels peak around 10 days; then red cells are restored by 4-8 weeks after haemorrhage



Ward Call:

Just when you are about to end your shift, you get the call:

“Hi Dr, I just wanted to flag a Mrs Boop on 3A who has had low urine output for the past few hours. She already has an indwelling catheter in situ but just thought I would let you know.”

How could you decide if this is anything to worry about (you are, of course, allowed to ask questions over the phone), and are there any instructions that could be given over the phone to potentially fix the issue?

…….so you can go home.

Have a think and meet me further down.




Case:

A 36-year-old female presents to the Emergency Department with a 3-day history of productive cough and fever. On admission, her temperature was 38.3°C, BP 105/62 and heart rate was 126 bpm.

This is her chest x-ray:

What is the most likely organism contributing to this clinical picture?

  1. Klebsiella pneumoniae

  2. Haemophilus influenza

  3. Streptococcus pneumoniae

  4. Legionella pneumophila

  5. Mycobacterium tuberculosis

Have a think and meet me at the bottom.




On Urine….

Some questions you can ask to determine if this call about reduced urine output is an issue include:

  • How much urine has been passed in the past 24 hours v last couple of hours?

  • Is the patient complaining of abdominal pain?

  • What are the vitals?

  • Does the patient look sick?

  • What was the reason for admission? AND;

  • What does the patient weigh?

If the patient looks well, has no symptoms of urinary retention and is passing at least 0.5ml/kg/hr, then this is almost certainly not a problem and certainly should not be triaged over reviewing sick patients. Remember that small patients only need to pass small amounts of urine - this is still normal.

And you might even be able to fix the whole problem by asking the nurse to “flush the catheter” to remove any sediments or clots.

…..then go home….

(Adapted from ‘On Call’- Cadogan, Brown and Celenza)




What caused the Moist Cough?:

Clear case of right middle lobe lobar pneumonia. 

  • Characteristic opacification in a lobar pattern

  • Sharply defined at the fissures

  • Evidence of air bronchograms. 

The most common cause of, in this case, a community acquired lobar pneumonia is Streptococcus pneumoniae.



Bonus: So what is a reticulocyte?

Answer in tomorrow’s dose.



News: I made a little Ward Call Course for you all. It maps out an Evening Ward Call shift and covers a bunch of common tasks that you may need to do, like:

  • Deteriorating Patients

  • Heparin Infusions

  • Fluid Orders

  • Electrolyte Replacement

  • Difficult patients - Discharge Against Medical Advice, Ryan’s Rule

  • End of Life etc

You can find the course page here:

Ward Call Preparedness

It’s free and always will be. Let me know what you think.


Thanks for reading Your Daily Meds! Subscribe for free to receive new posts and support my work.


Or you might consider sharing this post with someone else who might find Your Daily Meds useful.

Share


Remember, you are free to rip these questions and answers and use them for your own flashcards, study and question banks.

As always, please contact me with any questions, concerns, tips or suggestions. Have a great day!

Luke.

Share
Share this post

Your Daily Meds - 8 December, 2022

yourdailymeds.substack.com
Comments
Top
New
Community

No posts

Ready for more?

© 2023 Luke Reynolds
Privacy ∙ Terms ∙ Collection notice
Start WritingGet the app
Substack is the home for great writing