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Living Healthfully - January 2012

Animal Bite and Cellulitis-PART2

January 31st 2012 11:23


its more fun in the philippines


Patient’s environmental history revealed that people in their neighbourhood have reported sighting of snakes in their area. Patient lies on a matted floor at night. We therefore cannot remove the idea of snake bite, knowing the resemblance of snake teeth. But not all snakes are venomous. And if venomous snake attacked him, the evolution of symptoms of poisoning can only take from minutes to hours- going from local manifestation to systemic. Common manifestations include local and systemic vascular leakage, swelling, coagulopathy, and bleeding, and circulatory compromise. Other venoms are neurotoxic leading to local or generalized weakness, including respiratory muscle paralysis. Systemic findings can also include changes in taste, dryness of mouth, mouth numbness, muscle fasciculations, tachycardia or bradycardia, hypotension, pulmonary edema, and renal dysfunction (Harrison’s Principle of Internal Medicine, 17th edition). Loss of consciousness can also be observed. These are actually the things that would also indicate antivenom administration. In his case none of the above was present. And so even if our patient was bitten, antivenom is not warranted. ERGO, NOT ALL PATIENTS WHO HAVE BEEN SUSPECTED TO HAVE BEEN BITTEN BY SNAKES REQUIRE ANTIVENOM ADMINISTRATION.



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Animal Bite and Cellulitis-PART 1

January 29th 2012 10:52
RD, a 49 year-old male came in with complaints of pain and swelling at the pretibial aspect of the left leg, following a seemingly infected wound site. The wound apparently was incurred about 6 days ago as patient claimed to have woken up one morning having two puncture sites on the said area, resembling an animal bite. It was not bleeding and patient felt minimal pain over the lesion. Upon questioning, patient did not recall of any incidents that could have caused the injury. After few days the pain on the site became worse, coupled with mild swelling, warmth, and erythema. Patient initially consulted a company physician. He was advised to take Cloxacillin, and claimed to have been compliant with the medication. The lesion however, even grew worse. He had difficulty in walking. Swelling and erythema progressed from being just around the wound site to being almost on the whole pretibial region and left foot. Exudates are seen on the wound area.

its more fun in the philippines, health, cellulitis, animal bite


By merely inspecting the lesion, we are sure that cellulitis is present. However, another main concern in this patient is whether he was actually bitten by an animal or not. And if he was, what animal bit him? These questions are important to our anticipatory management later on. Yes there is no question that since cellulitis is present, antibiotic therapy is warranted together with proper wound care. It is also true that for puncture wounds, it is good practice to administer ATS and Tab. But what if he was bitten by a rabid animal? What if he was bitten by a venomous snake? We need to anticipate and prevent future complications brought about by venoms or infections from animal bites. As an example: Is it not that if we suspect a person to be bitten by a rabid animal we give rabies vaccine and immunoglobulin? Another example: If a person is bitten by a venomous snake, close observation is warranted in order to determine the signs and symptoms that would indicate antivenom administration.

TO BE CONTINUED...
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Acute Gastroenteritis-Part 2

January 28th 2012 09:28
In this case we are pretty much sure that this is acute gastroenteritis, especially if it is clear in our history that the condition is food-related (though not all gastroenteritis are such). Fortunately no signs of dehydration were noted. At the back of our mind however, we should not forget surgical conditions like bowel obstruction, gall bladder disease, or appendicitis. Bowel obstruction initially can manifest with hyperactive bowel sounds. It can also manifest vomiting and overflow diarrhea. Any inflammation within the peritoneum can cause hypoactivity or hyperactivity of the gastrointestinal tract like gall bladder disease or appendicitis. These differential diagnoses however should not be considered unless close observation of the pattern and location of abdominal tenderness and other symptoms was done.
Knowing this, what are the possible problems we anticipate? Dehydration and electrolyte imbalance may ensue. Therefore adequate fluid intake has to be ensured. Baseline serum potassium and sodium has to be determined since in vomiting we expect potassium loss and in diarrhea sodium is expected to be lost. Hydration is started in anticipation that diarrhea and vomiting shall continue. Personally we would start on oral rehydration. However if she would not tolerate such management because of persistent symptoms, this will be the time that we shift to intravenous fluid administration. As for dietary management, diet as tolerated is indicated if vomiting ceases. If vomiting ensues, NPO is indicated temporarily. We can then gradually progress to soft diet, low salt, low fat.
Is fecalysis always needed? No. We would order fecalysis in the following conditions: bloody stool, recurrent diarrhea, or history of worms moving out from the bowel.
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Acute Gastroenteritis

January 26th 2012 09:22
AE, 33 years old, female came in with complaints of 6 to 8 episodes of vomiting of previously ingested food and watery lined stool after eating shellfish. No fever was noted. She was conscious, coherent, not in distress, and seemingly with no signs of dehydration.
clean hospitals, good hospitals in the Philippines
Our hospitals are excellent and clean here in Manila.

A history of vomiting and diarrhea can obviously tell us that her problem is gastrointestinal. But which among the gastrointestinal conditions are we going to consider? This question is very important since we have to establish a correct diagnosis so that we can institute a correct and cost-efficient management. Physical examination to complement our history is therefore warranted. Pertinent physical findings are the following: blood pressure of 100/60 mmHg, heart rate of 72 bpm, respiratory rate of 20 cpm, and temperature of 36.8 deg Celsius. Abdominal examination revealed flat, soft abdomen with direct tenderness on the epigastric area with hyperactive bowel sounds


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On Respiratory Infections: A case discussion (PART 2)

January 24th 2012 09:12
At this point, we would like to comment on the use of chest x-ray in diagnosing respiratory problems. We have to be reminded that x-ray is just an adjunct to our diagnosis. Diagnosis of most of the respiratory problems is clinical. Some of indications of chest x-ray include: determination of pathogens causing the disease (streaky infiltrates point to viral infection), or ruling in tuberculosis, and others.

respiratory infection

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On Respiratory Infections: A Case Discussion

January 22nd 2012 09:11
Hello everyone! I would like to share to you a case which is very common in our medical practice. I hope I can impart something. And further look forward to comments about what other practitioners could have done in this case. THANK YOU!

RU, a 56 year-old female, complains of difficulty of breathing, fever, and occasional non-productive cough. Upon physical examination, she manifested congested turbinates, postnasal drip, and slightly hyperaemic pharyngeal walls. Auscultation revealed harsh inspiratory breath sounds


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What Vitamins are Not?

January 5th 2012 15:22
healthy baby



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Dietary Recommendations Regarding FATS INTAKE

January 3rd 2012 13:08
What did you eat?


HAPPY NEW YEAR EVERYONE! I never really wanted to spoil your eating and party-ing...well here I am just the same for reminders...We don't want to get ourselves in trouble as 2011 arrives. Believe you me! This season is not only a season of happiness and eating spree. This is also a season of heart attacks and strokes...Am I being negative? Hehe...Pardon me... But please be careful with what you eat this time of the year


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