Finding Air

Prior to ending my duty this morning, a patient suddenly complains of difficulty in breathing. Nebulization and IV steroids were rendered but still his difficulty in breathing was not relieved. Wheezes were noted in both of his lung fields. Arterial blood gas was requested and revealed respiratory acidosis. Patient eventually improved with intermittent ambubagging. He is a diagnosed case of chronic obstructive disease but with poor compliance to his medications. Patient was eventually admitted due to worsening dyspnea which started 3 weeks ago.

Chronic obstructive pulmonary disease (COPD)is a progressive disease which makes one hard to breathe. The most common cause of COPD is smoking, usually higher among chronic smokers. Symptoms usually include chronic cough, difficulty in breathing (dyspnea), tachypnea, labored breathing, etc. Diagnosis is done with taking a lung function test. Management strategies include smoking cessation, use of B2 agonist inhalers and nebulizers, vaccinations, and for some patients they would need long term oxygen therapy even at home and for some, lung transplantation.

Long Weekend

Aside from the weekend, Monday and Tuesday are declared holiday in our country due to National Heroes Day and the end of Ramadan respectively. A much needed rest from Saturday's hectic duty which a lot of patient's came for ER consult most of them due to fever. Will be on duty again tomorrow, planning to sleep the whole day. Zzzzzzz

Blood in the Brain

Before ending my duty today, a 34 year old male was brought to the ER unresponsive. Patient was seen approximately an hour before lying on the floor and noted to have drooling of saliva. Upon arrival at the ER, patient was noted at GCS 4 with anisicoria. A cranial ct scan revealed an intraventricular bleed with an amount roughly reaching 100cc. Patient was intubated, hook to mechanical ventilator and admitted under neurosurgery service.

CVD bleed or hemorrhagic stroke occurs when a blood vessel in the brain ruptures and spills blood causing in compression to the other brain structures. They are more likely to have headache, altered mental status, seizures, nausea and vomiting, and/or marked hypertension, however this mentioned symptoms could also be seen on ischemic stroke cases. It can be cause by hypertension, an aneurysm or less common from an AV malformation. The amount of blood/bleeding determines the severity of the disease and the possible prognosis of the patient.

Pulmonology Lecture

Today I attended a pulmonology lecture at a prestigious hotel in one of the cities here in Metro Manila. The topics included ventilator acquired pneumonia, a case of viral pneumonia with neurologic complications was presented, recent super bugs in community acquired pneumonia and many more. Aside from the learning experience, the food served was great. Even though it was a tiring day, the lecture was worth it. I ended the day eating pizza in front of the hospital.

TIA vs Stroke in Evolution

Last night I came across a 36 year old male Japanese, who consulted the emergency room due to left sided numbness. It came suddenly while the patient is drinking coffee, no headache nor dizziness were associated with the numbness. At the emergency room, patient was then noted wit slurring of speech, facial asymmetry and eventually left sided weakness. A couple of hours after the above events, I went back to the patient to see how he is doing and it surprised me that the above symptoms were gone. Left sided weakness was not appreciated, slurring of speech and facial asymmetry were also not noted. It came to me that this might be a case of transient ischemic attack or maybe its a beginning stroke.

TIA or transient ischemic attack is defined as a neurologic deficit like weakness or numbness which usually resolves within 24 hours. Usually having a TIA is a sign that the patient is in impending stroke or might proceed to stroke. As with stroke, TIA also shares the same etiology which is disruption of blood flow to the brain. Early detection is important.

For the patient last night, hopefully he could recover from his neurologic deficit and be back to his normal life after his hospital stay.

Dengue Explosion

Dengue fever cases are soaring in the country. Numerous outbreaks have been reported in different parts of the nation and several mortalities were also noted. Currently at the hospital, the number of cases are also on the rise especially in the pediatric service. Lucky for us, most if not all cases of dengue in the hospital do not need any blood transfusion.

Dengue fever is a viral disease transmitted usually by the dreaded Aedes mosquito. Symptoms usually include fever, headache, body malaise, joint points and some would present with a skin rash. Symptoms usually appear 3-14 days after a bite from an infected mosquito,. There are severe forms of dengue, which usually has bleeding, thrombocytopenia and hypotension.

Treatment of dengue fever is usually supportive, IV or oral hydration, anti pyretics for fever, and usually for the severe forms transfusion might be necessary. Currently there are no vaccines for dengue, but we can do preventive measures to avoid the disease. Prevention is done by emptying water containers, cleaning canals, wearing protective gears to avoid mosquito bites, etc.

Dengue fever may be lethal if left untreated, early recognition is important together with preventive measures to avoid its spread.

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Health Revisited

A Night of Referrals

Last night saw the skies drip with rain which started strong but ended quickly. The hospital was filled with a sudden cold breeze and referrals from different services poured like the rain outside. Referrals from the Surgery and OB service poured like the rain outside, but gladly it stopped with the rain going to a halt. One referral was for hematology co-management and clearance, two were for cardio-pulmonary clearance prior to surgery, another one was for diabetes management in a pregnant patient. Good thing, they stopped by the time the rain pour ended.

Multiple specialties handling the case could further improve the management and treatment of the patient. The strength of one might complement the strength of the other. Viewing things from difference perspectives may further enhance the outcome of the patient. Two heads are better than one as they say.

Health 101

As the saying goes "Health is Wealth", staying healthy is one though priority for everyone of us. Even economists would agree that a healthy population would increase the economy.  I'm a doctor in the middle of my residency, and would like to share some views, points and experiences regarding the word "Health"