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12 Key Accidental Discoveries in Medicine Steven Rourke | August 8, 2017 | Contributor Information  The path to medical discovery tends to follow a scenic route, one that takes unforeseen twists and turns to arrive at surprising destinations, well off the beaten track. In the following slides, we explore some of science's most unlikely findings and celebrate the scientists whose brilliant minds, sense of intellectual adventure, and keen powers of observation helped chang...
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Drugs & Diseases > Fast Five Quizzes Fast Five Quiz: Are You Familiar With Key Elements Regarding Heat Stroke? Richard H. Sinert, DO August 02, 2017 问题1. Which of the following is an indicator of poor prognosis during acute episodes of heat stroke?热射病急性期的以下哪种表现提示预后不良? A. Lactic acidosis in patients with classic heat stroke 经典热射病患者出现乳酸酸中毒 B. Aminotransferase levels > 800 IU/L during the first 12 hours 最初12小时转氨酶> 800 ...
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Drugs & Diseases > Fast Five Quizzes Fast Five Quiz: Are You Familiar With Key Elements Regarding Heat Stroke? Richard H. Sinert, DO August 02, 2017 Heat illness may be viewed as a continuum of illnesses relating to the body's inability to cope with heat. It includes minor illnesses, such as heat edema, heat rash (ie, prickly heat), heat cramps, and heat tetany, as well as heat syncope and heat exhaustion. Heat stroke is the most severe heat-related illness and is...
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Images in Clinical Medicine Left-Middle-Lobe Pneumonia Ling Yuan Kong, Yves Longtin N Engl J Med 2017; 377: e8 DOI:10.1056/NEJMicm1700661 A 34-year-old man presented to the emergency department with a 5-day history of fever, cough, and dyspnea. He had received a diagnosis of situs inversus when he was 2 years of age, after a chest radiograph had been obtained in order to evaluate a cough. Physical examination was notable for heart sounds in the right side of his chest and...
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CASE VIGNETTE A Woman with Septic Shock Rebecca E. Berger, M.D. http://www.nejm.org/doi/full/10.1056/NEJMclde1705277#discussion Editor's Comment Management of Septic Shock — Polling Results Rebecca E. Berger, M.D., and Julie R. Ingelfinger, M.D. Management of septic shock was transformed in 2001 with the publication of the randomized, controlled trial, “Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock,” by Emanuel Rivers and colleagues.[1] Tha...
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Imaging in Intensive Care Medicine Resuscitated unconscious male: Lichtenberg’s sign lighting the way Andrew Lindford, Jyrki Vuola, Esko Kankur Intensive Care Medicine 2017; 43: 1148–1149 An intubated unconscious 18-year-old male was admitted to the trauma center with a fern-leaf erythematous pattern on his right chest and flank, a second-degree upper chest burn, and a deep full-thickness occipital scalp burn (Fig. 1a). Earlier in the day his military unit had completed...
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Chest X-Rays: 16 Subtle But Key Findings You Need to Know Lars Grimm, MD, MHS | August 2, 2017 The chest radiograph is one of the views most commonly ordered by clinicians, and it is frequently first viewed by non-radiologists. Although many disease processes are obvious at first glance on chest radiographs, clinicians must be careful not to miss more subtle findings. This image shows a solitary pulmonary nodule (circle) in the left midlung. Image courtesy of Lars Grimm, ...
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Imaging in Intensive Care Medicine Echography of pneumatosis intestinalis and hepatic portal venous gas in a patient with septic shock Jiaqi Xu, Shangzhong Chen, Jing Yan, Jianjun Zhang Intensive Care Medicine 2017; 43: 1152–1153 An 88-year-old male patient was admitted to our ICU with a diagnosis of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and respiratory failure. During hospitalization the patient presented with abdominal pain, abdominal dist...
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CASE VIGNETTE A Woman with Septic Shock Rebecca E. Berger, M.D. http://www.nejm.org/doi/full/10.1056/NEJMclde1705277#discussion Ms. Jones is a 65-year-old woman with a history of hypertension who presents to the emergency department with a 3-day history of chills and dysuria. The only medication she is taking is amlodipine, at a dose of 10 mg daily; she had had normal electrolyte levels and renal function at a routine visit 6 weeks earlier. On arrival at the emergency dep...
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IMAGES IN CLINICAL MEDICINE Mobile Aortic Thrombi Ville Sallinen, M.D., Ph.D., and Pirkka Vikatmaa, M.D., Ph.D. N Engl J Med 2017; 377:e2 July 13, 2017 DOI: 10.1056/NEJMicm1702263 An 85-year-old woman with essential thrombocytosis, coronary artery disease, and a remote history of venous thromboembolism presented with abdominal pain, fever, vomiting, and diarrhea. Physical examination revealed tenderness and guarding in the lower abdomen. Laboratory results showed a white-...
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