18/04/2024
Sodium-glucose transporter 2 (SGLT2) inhibitors such as Jardiance is being increasingly used in patients with type 1 or 2 diabetes.
These patients are at an increased risk of a condition known as euglycemic diabetic ketoacidosis (EDKA) - which can be tricky to detect.
In the surgical setting it is worth noting that patients who are treated with SGLT2-i and present to the ED setting with for example intestinal obstruction or fasting states are at an increased risk of EDKA (from a real life experience a few weeks ago).
So here’s a post to freshen up your medical knowledge and maybe help you identify it with more ease in the future ☺️
Ref: PubMed & DynaMed
20/03/2022
Autoinjectors like EpiPen are preloaded with epinephrine and considered the first line treatment of anaphylaxis. These epinephrine autoinjectors should immediately be administered by the patient if they feel any of the following;
💉 Experience trouble breathing
💉 Have a feeling of tightness in the throat
💉 Feel lightheaded or feel as if they might pass out
In adults the administered dose is 0.3mg intramuscularly in the mid outer thigh.
Retrospective studies have shown that around 35% of patients suffering from anaphylaxis require a second dose, which can be given 5 to 15 minutes after the first one. Consider a second dose is symptoms are not stabilizing or improving.
Remember: blue to the sky, orange to the thigh!
Ref: Medscape, UpToDate
26/02/2022
Not much of a topic today, just this drawing of a cystoscope I did a while back - why? I haven’t had time to prepare any other topic 😇
I’m also about to finish my first 36 hour shift as a resident - a shift I’m very proud of for several reasons. I won’t bore you with the details but this shift really reminded me of how much I’ve grown since I started working in 2018. I felt like I had control and trusted my gut, even if there were challenges along the way 😅
Happy with what I did. Learning from what I didn’t know. That’s the way!
So perhaps a drawing of a cystoscope is the perfect way to remember this by. Who knows. All I know is that I’m ready for some much needed free time (and probably pizza) ✌️
Hope you guys had fun tagging along via stories, it was so much fun to chat with you in between the cases!
//Arad
23/02/2022
🫀Aortic valve stenosis🫀
There’s much to be said about this chronic progressive disease, but here are a few things to keep in mind that have popped up on my previous exams when I was a medical student (hopefully you’ll score some points with this):
📚 Causes 📚
- Most commonly due to calcific aortic valvular disease
- May also occur due to rheumatic fever 🔥
📚 Pathophysiology 📚
- With worsening stenosis there’s increasing obstruction which leads to incomplete left ventricular emptying
- The increased work against the stenosis leads to left ventricular hypertrophy, and in turn relative ischemia
- The relative ischemia affects the myocardium, resulting in angina, arrhythmias and left ventricular failure
📚 Symptoms 📚
- Usually no symptoms until the stenosis is moderately severe
- Typical is exercise-induced (❗️) syncope, angina or dyspnea
📚 Auscultation 📚
- Ejection systolic murmur, described as “diamond-shaped” (crescendo-decrescendo) heard best in the aortic area
- Radiation can be heard to carotid arteries (❗️) and also precordium
📚 Classification of severe stenosis 📚
- Valve area 4.0 m/s
- Mean transvalvular gradient >40 mmHg
📚 Management 📚
- For symptomatic patients with severe AS, early intervention with aortic valve replacement is recommended (performed surgically or percutaneously)
- Treatment of asymptomatic patients with severe AS is controversial, but intervention is recommended if there is impaired left ventricular function
- In asymptomatic patients the main goal is disease monitoring as no therapy so far has shown to delay disease progression. If symptoms appear, prompt intervention is recommended
Ref: UpToDate, Clinical Medicine by Kumar & Clark, 2021 ESC/EACTS Guidelines
27/01/2022
The third and final part of cancer awareness campaign focuses on signs and symptoms related to urinary bladder cancer. This is, of course, a topic that is close to my heart ☺️
If anyone has seen a urinary bladder cancer via cystoscope you’ll know that they are often pinkish and fluffy looking - which is what I wanted to showcase here 😄
26/01/2022
Part 2 of awareness campaign is focused on malignant melanoma. Here I wanted to illustrate the “ABCDE-criteria” which is a value tool to use when evaluating skin lesions.
Enjoy! 🤩
25/01/2022
It is live! The cancer awareness campaign I worked on with is up on their website and ready for you to enjoy 🤩
The goal of the campaign is to be conscious about certain alarming signs and symptoms that can occur in lung cancer, malignant melanoma and urinary bladder cancer. MSD was looking for a way to illustrate the campaign and reached out to me earlier last autumn, could I say no? No, I couldn’t. Was I nervous about the fact that I might not be able to create what they wanted or needed? Yes, don’t even get me started.
Anyways! Now that the campaign is live I’ll be able to post the translated versions here on my page for you to see 🤩 I’m so proud with the end result and really wanted to maintain my esthetic and “touch” while using their color palette and create something informative.
I truly hope you guys will enjoy them. And sorry for the absence.
First up - lung cancer!
02/11/2021
Kidney replacement therapy (dialysis) has a few urgent indications when it comes to patients with acute kidney injury. These are (of course) a fan-favorite for all exams that have some kind of nephrology-related questions in them, so beware 😉
🩺 Clinical tip: Dialysis can be initiated if a patient with AKI does not fulfill an urgent indication listed in the picture, but who has an unlikely chance to resolve quickly
Hope this helps!
06/09/2021
🚿 Uroflowmetry 🚿
A few weeks back I found this great article on uroflowmetry published by the BJU International. I thought I’d give it a try and do my own spin on it - and here’s the final result which might be useful to some of you? 😎
Today was also such an incredibly exciting day in the OR. I’m still at the very beginning but I can see myself improving, becoming more confident and knowing what to do (sort of) and how to do it (sometimes). It’s an amazing feeling, and so far my first eight months at the clinic have been a dream come true.
Here’s hoping I’ll get into the residency program soon 🤩
Ref: BJUI
24/08/2021
🫁 Cystic fibrosis mnemonic 🫁
Cystic fibrosis (CF) is an inherited disease with an autosomal recessive pattern, meaning that an individual needs to inherit two copies of the abnormal gene for the condition to be present.
The resulting mutation affects the channels responsible for transporting sodium and chloride across secretory epithelia - this in turn leads to thickened and viscous secretions 🧬
The tricky part about CF is that it can affect so many different organs, and so the presentation can vary from individual to individual. Like so many other difficult subjects there's a very handy mnemonic to help you! 😎
Ref: Step Up To Medicine, 4th Edition &
UpToDate
19/08/2021
🦠 Ascending cholangitis 🦠
This nasty inflammation of the bile duct usually occurs due to stasis, which can occur due to gallstones or tumor compression. But on the exams (for some reason…) you will 90% of the time be presented with a case that has recently undergone endoscopic retrograde cholangiopancreatography (ERCP) - so keep that in mind!
Another exam-favorite that always pops up is the symptoms of ascending cholangitis. They are classified as “Charcoat’s Triad” and “Reynold’s Pentad” - check the slides and secure those exam points 😎
Ref: UpToDate, Medscape
01/08/2021
💨 Smoke inhalation injury 💨
Well, here it is! It took a little reading, a little thinking, a lot of redrawing and then some more reading - but the smoke inhalation injury topic is ready for you. As always I tried to keep the balance between making the topic clinically relevant, as well as having it be useful for exams 📚
I realise there are a few bullet points which can be a topic for discussion, for example the decision to do tracheostomy (which is still a bit of a controversial topic) or the incidence of cherry-red skin in the clinical setting - but I'll leave it as it is.
Hope you'll enjoy it! I know I had tons of fun, learned so much and even got to try a few new tricks on Procreate 😎
Ref: UpToDate & Medscape
26/01/2022
25/01/2022
02/11/2021
06/09/2021
24/08/2021
19/08/2021
01/08/2021