Wednesday, June 07, 2006
Finally I move my blog to wordpress
Since I now know how to upload original image in my new blog page in wordpress, this blogger website will be concluded here.
Try to visit my blog in wordpress here.
http://erpalm.wordpress.com
Try to visit my blog in wordpress here.
http://erpalm.wordpress.com
Thursday, April 13, 2006
2 big movies coming up next month
Mission impossible III is coming next month on May 5, 2006.
Poseidon is coming next month too on May 12, 2006.
Thursday, March 09, 2006
Bradycardia+headache E4M6V5
Recently I encounter a 60 y/o male patient c/o headache 2 days ago and now still dizziness, nearly faint and unstable gait when standing. He came to triage with vital signs: 145/81 45 20 36.6 C. Coma scale E4M6V5. I am wondering there is no chest tightness nor chest pain, why the EKG showed sinus bradycardia. But patient mention he had unstable gait that nearly tilted to one side on standing, so I order a brain CT scan and shown above. What do you see and what will you do?
##Still trying wordpress blog page but the size of photo is too small, so I upload this case here in blogger##
Saturday, March 04, 2006
My new blog page by wordpress
Recently I had created a new blog page by wordpress which can catergorize all my previous posts as a reference. Since I am still not familar with the functions of the new blog and need more try, I now using both blogger and wordpress alternatively and will be merged in the coming future. Let's wait and see. Check my new blog page here.
Leptospirosis present with jaundice, acute hepatic failure and renal failure.
Today I encounter a case of 28M noted body weight loss, poor appetite, jaundice, tea-color urine, lab data showed hypoxemia, acute renal failure, acute hepatic failure, prolong PTT, Dimer>2.0, FDP>32. Clinically suspected leptospirosis. Blood culture and pleural effusion had sent for examination but results are pending.
Here are some URLs for leptospirosis:
Leptospirosis from eMedicine
Leptospirosis Information Center
Leptospirosis Facts
Leptospirosis from medical students Britain
Here are some URLs for leptospirosis:
Leptospirosis from eMedicine
Leptospirosis Information Center
Leptospirosis Facts
Leptospirosis from medical students Britain
Thursday, February 23, 2006
Addin just bookmarks just for further reading
Tonight I read across some good links for further readings:
PSP fanboy
X'S Drive MP3 VP3650
Digital photography weblog
PDAnewsclip
Blogger use by furl
Engadget chinese
Writing weblog is just a beginning but maintainence is a great job.
However, you can ask bloggers from all around the world by internet and visiting other bloggers' websites. Knowlege is not only reading from books but from internet also. I need to work hard in order to manage my blog news in the further.
PSP fanboy
X'S Drive MP3 VP3650
Digital photography weblog
PDAnewsclip
Blogger use by furl
Engadget chinese
Writing weblog is just a beginning but maintainence is a great job.
However, you can ask bloggers from all around the world by internet and visiting other bloggers' websites. Knowlege is not only reading from books but from internet also. I need to work hard in order to manage my blog news in the further.
Hong Kong Tea Restaurant
Recently I read a newspaper introducing HK style tea restaurant in local Taipei city.
Anyone who is interested may go to try- cheap and delicious.
Sunday, February 19, 2006
Does diagnosis acute appenditicis affect by decreased WBC count?
A 49 y/o male patient came to ER due to severe epigastric pain shift to RLQ pain. WBC 19400 seg 92. We consulted GS and said appendicitis is not likely at present moment due to no rebound pain and suggest followup WBC +DC 6hrs later. Followup WBC+DC showed 13500 Seg 67 CRP 3.9 and patient felt better and felt some hungry. What will you do? Let him try feeding and discharge him or tell him appendicitis is not likely due to WBC count decreased?
I check the patient who looks rather fat and obese abdomen. PE showed tenderness over Mcburny's point on deep palpation but marked rebound pain due to obesity. Bedside echo didn't showed any target sign but there is local tenderness during ultrasound examination. Abd CT showed enlarged appendix with wall thickening and perifocal fatty stranding(illustrated above). Operation showed engorged appendix with no perforation.
Discussion:
1. Acute appendicitis is diagnosed by clinically but not by laboratory data.
2. Followup WBC count if decreased does not mean decreased possibility of appendicits.
3. Don't rely too much on lab data or imaging, just rely on your basic physical examination.
Saturday, February 18, 2006
Bedside ultrasound use in diagnosis of PPU.
A 42 y/o female patient c/o sudden onset of epigastric pain since last night. PE showed marked epigastric tenderness but no rebound pain. BS is hypoactive. One of our resident check the patient and order a plain abd view and showed much stools but no free air. Primperan IV and eva enema is given by order. When I performed the bedside ultrasound, I found a lot of interruption echoic lying over right liver. I turn the patient to left decubitus view and showed free air in subphrenic area. Of course, my favorite X ray for diagnosis PPU-- chest left decubitus view first followed by standing CXR and standing plain abd. Since the patient cannot stand up for x ray examination(a hint for diagnosis of PPU), we take only the first 2 x rays and that are sufficient for diagnosis and finally call the surgeon for emergent operation. Operation findings showed PPU of course.
My ultrasound experience: Left decubitus position perform ultrasound>> If free air seen>> Go for X ray for chest left decubitus view>> standing CXR and standing plain abd.
