In Honor of Dr. C. Everett Koop

Dr. C. Everett Koop, former Surgeons General, 1937 graduate of Dartmouth, and founder of the C. Everett Koop Institute at the Geisel School of Medicine died peacefully at his home in Hanover this afternoon.

I had the distinct pleasure and honor of meeting and dining with Dr. C. Everett Koop at a Dartmouth event a few years back. In addition to his numerous contributions to medicine, he was a kind man with great stories to share. 

He pioneered numerous advances in pediatric surgery, and trained and mentored many of the leaders now in this field. As one of our country’s greatest Surgeons General, he effectively promoted health and the prevention of disease, thereby improving millions of lives in our nation and across the globe. He founded the C. Everett Koop Institute at Dartmouth to transform healthcare and the process of educating health professionals.

To read more about Dr. Koop’s life and pioneering contributions to our world, please see: http://geiselmed.dartmouth.edu/koopmemoriam/.

Carpal Tunnel

Carpal Tunnel

See below for the answers.

What nerve is compressed in carpal tunnel?
What population is it most commonly seen in?
What are typical signs and symptoms?
Where is the anatomical location of the "carpal tunnel"?
Work up?
Treatment?

What nerve is compressed in carpal tunnel?
Median nerve

What population is it most commonly seen in?
Women 30-50 years old

What are typical signs and symptoms?
Wrist pain - numbness/tingling of thumb
Pain exacerbated with activities of wrist flexion
May awaken pt at night
Thenar atrophy

Where is the anatomical location of the "carpal tunnel"?
Between the carpal bones and the flexor retinaculum

Work up?
Clinical exams: Tinel's sign and Phalen's sign
EMG/nerve conduction study

Treatment?
neutral wrist orthosis
modification of activities that irritate
NSAIDs for inflammation control
steroid injections
surgery


Source: First Aid for the Wards (Le, Bhushan, Skapik)
Photos: www.methodistorthopedics.com , http://en.wikipedia.org/wiki/File:Carpal_Tunnel_Syndrome,_Operation.jpg

Managing Shoulder Injuries

The American Family Physician is the peer-reviewed journal put out by the AAFP and they often have great stuff. This is an older article, but still incredibly relevant.

A shout out to my ortho roots...

Management of Shoulder Impingement Syndrome and Rotator Cuff Tears

EEG Readings

YouTube is a fantastic resource (well, mostly). Recently I found this great video explaining EEG readings. It is helpful. Enjoy!

http://www.dizziness-and-balance.com/disorders/central/epileptic.html

Challenge Bowl Time

Interested in competing in the AAPA National Challenge Bowl this year? Check out some video footage from last year!

Challenge Bowl Video

Repleting K+

Electrolyte imbalances are something that you see a lot on your rotations - especially in internal medicine, emergency medicine, and surgery.

When thinking about repleting a potassium deficiency consider the following:

• Goal is of K is greater than 4 in any pt with active cardiac problems
• If your pt has nl renal function: 10mEq of KCl (IV or PO) will increase serum K by about 0.1mEq/L (so if your pt is at 3.6, about 40 mEq of KCl should help correct your patient)
• Don't replete if patient is on dialysis (consult the dialysis team)
• f your pt has compromised renal function: divide the mEq of normal repletion by the pt's Cr (example: pt has Cr of 3, then you use 1/3 of the nl repletion amount - so instead of 9mEq, you'd use 3mEq)
• PO can cause nausea
• IV can be painful
• Typical combos: 10mEq/100cc or 10mEq/50cc (peripheral IV) and 20mEq/50cc (central line)
• Be careful when repleting its with renal insufficiency or in pts with high risk of tumor lysis

*This is not meant to substitute for clinical judgement, just suggestions to think about when treating K+ deficiencies in your patients.
Source: 
http://www.eric.vcu.edu/home/curriculum/print/Intern_Ward_Survival_Guide_2009.pdf
http://www.surgicalcriticalcare.net/Guidelines/electrolyte_replacement.pdf

photo: http://mattrosenart.deviantart.com/art/Potassium-195578504