BIOSOFT HELP FILES

This screens for alcohol abuse – C- have you ever felt you need to Cut down on your drinking, A – have people Annoyed you by criticizing your drinking, G – have you ever felt bad or Guilty about your drinking, E – Have you ever had a drink first thing in the morning to steady your nerves or get rid of your hangover as an Eye-opener.  2 yes’s identify an alcoholic who needs medical intervention

1)      Intermittent claudication

2)      Myofascial Pain syndrome - calf pain spreading up to the popliteal fossa in soleus MFPS, calf pain spreading down the heel cord to the heel plantar area as in soleus MFPS.  See notes on myofascial syndrome for diagnostic criteria and treatment details.

3)      Neurogenic claudication

4)      Chronic venous insufficiency

To exclude a cervical fracture in a patient with a neck injury – the patient population to whom it is applied – alert, not intoxicated, no distracting injury (ie. Long bone fracture or large lacerations), clinically a fracture can be excluded if 1) the patient is not high risk – age less than 65 yrs, no history of paresthesiae in extremities, no dangerous injury mechanisms like fall or heavy impact, And 2) patient has low-risk factors that allow a range of motions to be safely assessed like rear-end collision, seated position at the medical consultation, post-trauma ambulation,  delayed onset neck pain, absence of midline cervical spine tenderness And 3) the patient is able to actively rotate the neck 45* to either side

Valsalva maneuver usually causes an increase in HR followed by a decrease after stopping the maneuver.  The Valsalva ratio is the maximal HR by Valsalva divided by the lowest after Valsalva.  Normal > 1.21,  abnormal < 1.2.  Deep breathing causes an increase in HR by 15 BPM,  borderline 11-14, abnormal < 10 BPM. Standing causes an increase in HR by more than 10% from the 15-30^th beat on standing.  Less than 10% abnormal.  Sustained handgrip raises the BP > 16 mmHg, borderline 11-15, and < 10 mmHg abnormal.  Standing up reduces the BP < 10 mmHg, borderline 11-29, and abnormal > 30 mmHg. 

(Clark 2007)

First, make certain there is no carotid bruit, then exclude any history of stroke, TIAs, or amaurosis fugax.  If none of these are present apply pressure over the carotid artery at the level of cricoid cartilage for 5 seconds with a firm circular movement. If palpitations continue repeat the procedure on the opposite side.  Another vagal stimulant are Valsalva maneuver, applying an ice pack onto the face.

(Delacretaz 2006)

see under hair cycle

Implications of a minor negative event are blown all out of proportion.  Eg.  My chest pain is due to a heart attack, my headache is due to a brain tumor

1)      Cellulitis – a painful, red, warm, tender,  swollen area of a limb, no clear demarcation, the portal of entry – wound, ulcer, skin lesion, regional lymphadenopathy, Tx – mild-moderate or early infections can be treated as an outpatient, cephalexin 500 mg tid OR ciprofloxacin 750 mg bid 7-14 days, elevation of the foot and leg, cool sterile  saline compresses, econazole or miconazole or clotrimazole for tinea pedis, prophylactic use of penicillin 250-500 mg PO bid OR erythromycin 250 mg once or twice daily 

1)      Crepitus at the site of  cellulitis (clostridia and anaerobic infections, necrotizing fasciitis, anaerobic myonecrosis)

2)      Bullae and/or necrosis of tissues (necrotizing fasciitis, anaerobic myonecrosis)

3)      Gangrene (immuno-compromise, necrotizing fasciitis)

4)      Unusual onsets like – after animal or human bites (cellulitis of unusual organisms), after exposure to seawater, fresh water, muddy water (cellulitis of unusual organisms), illicit drug injection, breast surgery (cellulitis of unusual organisms), CABG, previously injured muscle (anaerobic myonecrosis), vaccination sites (vaccinia vaccination), liposuction (cellulitis of unusual organisms)

5)      Unusual sites like – periorbital, perianal, buccal

6)      High fever and the patient looks ill

7)      Quick progression of symptoms (necrotizing fasciitis)

8)      Involvement of deep tissues (necrotizing fasciitis)

9)      Progressive pain, swelling and tenderness (necrotizing fasciitis)

10)    Immunocompromise (unusual organisms)

(Swartz 2004)