Amusing typo

Flew on American Airlines yesterday and today.

The plane both ways was an Airbus A319, a smallish but perfectly nice plane. It had a really fancy infotainment system built into the back of the seats, and I enjoyed following the flight with this view selected:

IMG_0217

but there was something bugging me about one of the menus, so on the return flight (where an hour ground delay once we loaded up gave me some time to actually look) I found what had been making something in my brain itch:

IMG_2268

I sent this to @AmericanAir while waiting for the plane to park (their people-less parking system apparently doesn’t work in rain), and they were nice with the response:

Good for AA for having SoMe savvy people around!

ACEP Clarifies Campaign Rules

By James M. Cusick, MD, FACEP
Chair, Candidate Forum Subcommittee of the ACEP Council

ACEP is a member-driven organization with a representative body of our peers – the ACEP Council – chosen through component bodies, including our chapters (1 representative per 100 members), our Sections of Membership, and other aligned organizations.

Each year, this body democratically votes to establish ACEP policy and elect leadership positions. Candidates present themselves to the Council through written statements, scheduled speeches, and unrehearsed Question and Answer sessions during the Candidate Forum, which is open to all members. Elections must be fair, follow guidelines applicable to all, and be free of undue influence or pressure on candidates.

The ACEP Council’s Candidate Forum Subcommittee recently performed its annual review of the campaign rules to ensure a fair campaign and elections process for all Board of Directors and President-elect candidates. The changes were approved by the Council Steering Committee.

This year, restrictions on the use of social media were substantially relaxed to allow forms of communication most of us use on a daily basis.

In addition, protections were incorporated into the rules to keep candidate interviews in ACEP publications. Our goal is to avoid candidates being put in the position of commenting on College policy without adequate preparation and to ensure that the campaign process is fair and equal for all candidates.

Certain candidates may unfairly benefit from coverage in non-ACEP publications, while some may be disadvantaged. In order to ensure a fair election, campaign questions and the vetting of candidates is the responsibility of ACEP, its Council and its Council Committees.

If there are specific questions you would like asked of the candidates prior to the election, please send them to communications@acep.org. The Candidate Forum Subcommittee will consider them, the selected questions will be posed to candidates and their responses will be made public.

Elections will occur during the Council meeting on Oct. 26 in Chicago. The Nominating Committee has selected the final slate of candidates for 2014:

President-Elect Candidates
Jay Kaplan, MD, FACEP
Robert O’Connor, MD, FACEP
Rebecca Parker, MD, FACEP

Board of Directors Candidates (4 positions to be filled)
Stephen Anderson, MD, FACEP (WA)
Jon Mark Hirshon, MD, FACEP (MD)
Hans House, MD, FACEP (incumbent – IA)
Mark Mackey, MD, FACEP (incumbent – IL)
John Rogers, MD, FACEP (incumbent – GA)
Mark Rosenberg, DO, FACEP (NJ)

 

CASO 147: Edema de pierna derecha

El día 17/06/2004 acude una mujer de 78 años por presentar disnea de esfuerzo de una semana de evolución con dolor en costado derecho de características pleuríticas, febrícula, tos  y algún esputo hemoptoico de forma ocasional desde hace 2 días. Refiere también edema en pierna derecha de 2 semanas de evolución.

Antecedentes personales: HTA, Hipercolesterolemia. ACVA en 2010. Enfermedad de Alzheimer evolucionada con severo deterioro cognitivo y dependencia para todas las AVD.

Tratamiento habitual: Indapamida 1.5 mg/día. Simvastatina 10 mg/día. Rivastigmina parches de 9.5 mg/día. Memantina 20 mg/día. Trazodona 100 mg /noche. Sertralina 50 mg/12h. Citicolina 1 g/día. Bromazepam 1.5 mg a demanda.

Exploración general: PA 107/57 mmHg. Fc 87 lpm. Tª 36.3ºC. SO2 94%. Fr 22 rpm. Consciente, deterioro cognitivo ya conocido. Bien hidratada y perfundida. Taquipnea sin uso de musculatura accesoria. Ligera palidez. No IY. AC: rítmica. AP: roncus dispersos. Abdomen: blando sin dolor, sin masas ni visceromegalias. EID: tumefacta, empastada y con aumento de perímetro respecto a contralateral, sin signos inflamatorios externos salvo el edema.

Exploraciones complementarias:

* Analítica: Creatinina 0.93 / Urea 67 / Na 141 / K 2.46 / Glucosa 125 / Hb 10.7 / Htc 33.8 / VCM 86 / Plaquetas 247 / Leucocitos 13.100 (87%N 10%L) / INR 1.1 / Dímero D 943

ECG: RS a 85 x´. Q en D III. // * Rx de Tórax:

Caso 147 Rx Tórax

Comentario: edemas en piernas sugieren insuficiencia venosa o ICC entre otras posibilidades. Si el edema es unilateral, prioritario: DESCARTAR TVP.

* Ecodoppler venoso de EID: Trombosis aguda que interesa a la vena femoral común, totalidad de la vena femoral superficial y vena poplítea. La vena safena interna está trombosada en todo su recorrido a la altura del muslo y en su confluente femoral.

* AngioTAC: se visualizan defectos de replección a nivel de la porción distal de arteria pulmonar principal derecha y afectación de múltiples arterias subsegmentarias bilaterales. Infarto pulmonar a nivel del segmento posterior el LSD:

Caso 147 TEP

Trombo en arteria pulmonar principal derecha (marcado con la flecha roja).

7527034

Infarto pulmonar a nivel del segmento posterior el LSD.

JUICIO DIAGNÓSTICO:

- TROMBOEMBOLISMO PULMONAR BILATERAL con INFARTO PULMONAR en LSD

- TROMBOSIS VENOSA PROFUNDA de EID

- HIPOPOTASEMIA (un familiar refería que se aumentó la dosis de Indapamida, siguiendo el consejo de una vecina para disminuir el edema de la pierna!)

.

Comentario: Pienso que el caso presentado es didáctico: edema en pierna por la TVP; disnea de esfuerzo por el TEP; febrícula y hemoptisis por el infarto pulmonar.

Queda un problema por resolver: si la paciente sobrevive, cuánto tiempo se mantendría la ANTICOAGULACIÓN?. Con Heparina de bajo peso molecular subcutánea o con anticoagulantes orales?. Ha quedado reflejado que la  paciente presenta un severo deterioro cognitivo con dependencia completa para todas las actividades de la vida diaria. En cualquier caso, la Enfermedad de Alzheimer no es una contraindicación de anticoagulación, aunque si lo es el alto riesgo de caidas.  No sabría manifestarme al respecto.

 

 

 


Calcio antagonisti VS Beta bloccanti nel controllo della frequenza in tachiaritmia da FA.

     http://www.youtube.com/watch?v=aClYocQwtRI  Per gli appassionati di aritmologia, come il sottoscritto, i pomeriggi sono scanditi dalla continua ricerca e lettura di articoli inerenti la materia ed i farmaci per il controllo e la gestione dei ritmi cardiaci. Uno dei piu’ frequenti ritmi con i quali ci confrontiamo in pronto soccorso è la fibrillazione atriale e […]

The post Calcio antagonisti VS Beta bloccanti nel controllo della frequenza in tachiaritmia da FA. appeared first on EM Pills.

Calcio antagonisti VS Beta bloccanti nel controllo della frequenza in tachiaritmia da FA.

     http://www.youtube.com/watch?v=aClYocQwtRI  Per gli appassionati di aritmologia, come il sottoscritto, i pomeriggi sono scanditi dalla continua ricerca e lettura di articoli inerenti la materia ed i farmaci per il controllo e la gestione dei ritmi cardiaci. Uno dei piu’ frequenti ritmi con i quali ci confrontiamo in pronto soccorso è la fibrillazione atriale e […]

The post Calcio antagonisti VS Beta bloccanti nel controllo della frequenza in tachiaritmia da FA. appeared first on EM Pills.

El riesgo versus beneficio del LUCAS (dispositivo mecánico de compresiones torácicas). De revista Anesthesiology.

Existe un creciente interés por las compresiones automáticas que permiten frecuencia y profundidad constantes, lo que es crucial para optimizar la sobrevida. Esta editorial publicada en Anesthesiology analiza el tema, a propósito de un caso de rotura pancreática fatal probablemente por el dispositivo de compresiones torácicas automáticas LUCAS.
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