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Capnocytophaga canimorsus Infection Robert D.H. Markewitz and Tobias Graf N Engl J Med 2020; 383:1167DOI: 10.1056/NEJMicm1916407 A 62-year-old man presented to the emergency department with a 1-day history of fever and a 3-day history of chest pain. His medical history was notable for coronary heart disease and for a splenectomy that he had undergone after a car accident. Four days before presentation, he had been bitten on the left hand by his dog and h...
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Miliary Tuberculosis Jerald Pelayo and Kathleen Ruddiman N Engl J Med 2020; 383:e78DOI: 10.1056/NEJMicm2001934 A 56-year-old man presented to the emergency department with a 2-month history of fatigue, weight loss of 10 kg, night sweats, and fever. He had a cough producing sputum that was occasionally bloodtinged. He had immigrated to the United States from Haiti 10 years earlier. On examination, his temperature was 36.2°C. He was breathing comfortably but ap...
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Dissociated Oxygen Saturations by Dr Paul Young, last update March 16, 2019 aka Hematology Hoodwinker 004 One of the emergency residents has just taken an ABG on the 44 year-old woman in cubicle 3. Prior to her current presentation she had no known medical problems. The patient’s pulse oximetry reading is SpO2 98% on air. 急诊科的一名住院医师刚刚为一名44岁的女性患者做了动脉血气检查。此次发病前,患者没有既往病史。患者吸空气时脉搏氧饱和度(SpO...
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Dissociated Oxygen Saturations by Dr Paul Young, last update March 16, 2019 aka Hematology Hoodwinker 004 One of the emergency residents has just taken an ABG on the 44 year-old woman in cubicle 3. Prior to her current presentation she had no known medical problems. The patient’s pulse oximetry reading is SpO2 98% on air. 急诊科的一名住院医师刚刚为一名44岁的女性患者做了动脉血气检查。此次发病前,患者没有既往病史。患者吸空气时脉搏氧饱和度(SpO...
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Dissociated Oxygen Saturations by Dr Paul Young, last update March 16, 2019 aka Hematology Hoodwinker 004 One of the emergency residents has just taken an ABG on the 44 year-old woman in cubicle 3. Prior to her current presentation she had no known medical problems. The patient’s pulse oximetry reading is SpO2 98% on air. 急诊科的一名住院医师刚刚为一名44岁的女性患者做了动脉血气检查。此次发病前,患者没有既往病史。患者吸空气时脉搏氧饱和度(SpO...
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Dissociated Oxygen Saturations by Dr Paul Young, last update March 16, 2019 aka Hematology Hoodwinker 004 One of the emergency residents has just taken an ABG on the 44 year-old woman in cubicle 3. Prior to her current presentation she had no known medical problems. The patient’s pulse oximetry reading is SpO2 98% on air. 急诊科的一名住院医师刚刚为一名44岁的女性患者做了动脉血气检查。此次发病前,患者没有既往病史。患者吸空气时脉搏氧饱和度(SpO...
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Osmolar gap The osmolar gap is a diagnostic tool which can help identify the presence of some foreign solute in the body fluids. In the CICM fellowship SAQs, it mostly identifies young women who have ingested a toxic alcohol. Specific questions of this sort include the following examples: Question 7.2 from the first paper of 2014 - HAGMA, high osmolar gapQuestion 7.3 from the first paper of 2014 - HAGMA, normal osmolar gapQuestion 25.2 from the sec...
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Urinary electrolytes and the urinary anion gap Urinary anion gap The urinary anion gap is extensively explored in the chapter on the diagnosis of renal tubular acidosis. Its role in the SAQs has been limited to the diagnosis of renal tubular acidosis (i.e where it is used to discriminate between renal and non-renal causes of a normal anion gap acidosis, such as in Question 3.4  from the second paperof 2013). In brief: Urinary anion gap...
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The delta gap and delta ratio, advantages and disadvantages The delta ratio (or the equivalent delta gap) are diagnostic and analytical tools used to determine the contribution from extra anions to the acidaemia of any given acidosis. A much more detailed overview of the delta ratio is available in a dedicated chapter from the Acid-Base Disturbances series. Even though the calculation of a delta ratio is expected in every ABG interpretation que...
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Can we measure Plateau pressure during pressure support? And what does it indicate? Alice Grassi, M.D.Department of Anesthesia and Pain Management, University Health Network, Toronto School of Medicine, University of Milan Bicocca, Monza, Italy from https://coemv.ca/can-we-measure-plateau-pressure-during-pressure-support-and-what-does-it-indicate/ Pressure Support Ventilation is one of the most commonly used modes of assisted ventilation during the weaning phase....
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