Antibiotics for Appendicitis?

I have had quite the hiatus from blog entries recently. Life gets busy somehow. Ha. I recently had hip surgery and had some blog worthy experiences as a patient that I hope to write about soon - but for now, I came across this interesting article on a PA (Andrew Gray, PA-C) that refused an appendectomy in lieu of antibiotic treatment for his acute appendicitis. He made his choice based on the fact that he did not have insurance and the results of a Swedish study. It is a short read, but very interesting and have evoked some feisty comments.

Saving My Appendix: http://www.pulsemagazine.org

Passing the Time on the T with JAAPA

So the PA Journal (JAAPA) now has an application for the iPad. It has been out for a while now and I really like it! I download the most recent journal and am able to read it on the T on the way to work. It is great... it helps me keep up on the newest issues and clinical articles. The only downside is that it is only for the iPad currently... sorry no iPhones or iPods.

If you are an AAPA member, you get the journal for free along with the free CMEs in each issue.

Down load it at the Apple App Store:  Journal of the American Academy of Physician Assistants

Aphasia

I have always found aphasia incredibly interesting and terrifying all at the same time. Imagine not being able to communicate with language as smoothly as you do everyday. It is something that many of us take for granted.

Definition:
the loss or defect of language (speaking fluency, reading, writing, understanding of written or spoke words)

What are the 4 types of aphasia?
1. Wernicke's 
2. Broca's
3. conduction
4. global

Potential causes:

• stroke
• brain trauma
• brain tumor
• alzheimer's disease

Wernicke's

-receptive, fluent aphasia

-pt has hard time comprehending written or spoken language

-fluid speech, but difficult to understand

Broca's

-expressive, nonfluent aphasia

-speech is slow and requires effort

-few words used

-good comprehension of language

Conduction

-disturbance in repetition

-pathology involves the connections between Wernicke's and Broca's

Global

-often associated with RIGHT hemiparesis

-defect in all areas of language

How to treat
-many recover spontaneously in 4-6 weeks
-speech therapy



Photo source: emedia.leeward.hawaii.edu
Source: Step Up to Medicine by Agabegi and Agabegi

ACA Stroke Basics

Anterior Cerebral Artery (ACA) Stroke

The Anatomy

What deficits might you expect to see in a patient?

• contralateral leg weakness (both motor and sensory), frontal lobe behavioral issues, +/- aphasia if prefrontal cortex involved, grasp reflex

Where does the ACA receive its blood supply from?

• Carotid arteries

Source: http://www.neuroanatomy.ca/stroke_model/aca_info.html
Photo sources: http://missinglink.ucsf.edu/lm/ids_104_cns_injury/response%20_to_injury/watershed.htm

Oliguria

As always... back to the basics:

What is oliguria?
Low urine output (UOP)

What is "normal" adult UOP?
About 30cc/hr

How might you write a post op floor order for this?
"call house officer if 2 hour UOP is < 60cc"

What are the possible causes?
Think pre renal/renal/post renal causes

What is the most common cause?
Pre renal!