Normal Saline: The Coke of Crystalloid Fluids

In Medical Concepts by Brent Thoma15 Comments

The nurse looked up from my orders with a quizzical expression on her face. “Why do you always order Ringer’s Lactate?” She asked. I immediately launched into an intense discussion… errr… one sided conversation… about the merits of various IV solutions and their respective electrolyte values and pH. As her eyes quickly glazed over and she glanced at the clock her expression shifted to one of regret. I sensed that I was losing …

Group A Strep: The Stray Dog of Bacterias (Addendum)

In Medical Concepts by Brent Thoma9 Comments

Well consider me embarrassed! Last week I made a post on Group A Strep. As with most of my posts, it was intended to be an overview of a common topic discussing primarily discussing its pathophysiology. However, I definitely should have taken a little more time to delve into the efficacy and necessity of treatment with antibiotics. A huge thank you to Dr. Lars Peterson (@LarsKristofer), an EM resident from Rochester, NY, who …

Group A Strep: The Stray Dog of Bacterias

In Medical Concepts by Brent Thoma2 Comments

Sore throat. Group A Strep. It’s a presenting complaint we see almost daily that certainly doesn’t get anyone’s heart racing. I feel comfortable identifying the “sick” child, have a well-practiced “it’s a virus” speech, am adept in the art of the parent-facilitated tonsil swab, and generally think I diagnose and manage these patients fairly well. For a discussion of the Modified Centor Score and helpful PV card, see Academic Life in the EM. …

A Constipation Cocktail

In Medical Concepts by Brent Thoma4 Comments

Constipation, as defined succinctly by Urban Dictionary, is when you’ve gotta go, but your ass says “no!” It is a diagnosis that I can truly empathize with – who hasn’t been at least a bit bunged up before? The constipated patients that present to the ED take this everyday ailment to a whole new level. No one shows up a little constipated. Those that know they’re constipated come in as a last resort …

Urinalysis Voodoo

In Medical Concepts by Brent Thoma18 Comments

I must have missed the class on urinalysis interpretation in medical school.  When I hit the ward I didn’t have a clue.  Those first few weeks I nodded along knowingly when the residents talked confidently about how the patient did/did not have a UTI, initially being too embarrassed about not knowing something so simple to ask what, exactly, on the urinalysis led them to their conclusion.  A few rotations in I noted what …

I’m drowning in FOAM!

In Medical Concepts by Brent Thoma6 Comments

Over the past year my education has been enhanced by the wonders of Free Open Access Meducation (FOAM).  While I have found the innumerable podcasts and blog posts to be extremely educational, I’ve noticed a problem: I’m drowning in FOAM! For the most part, it is a good thing. I am learning a ton from the many podcasts and blogs that I follow. This was working out great until I got to the …