ACUTE COMPARTMENT SYNDROME

 ACUTE COMPARTMENT SYNDROME

The definitive surgical therapy for compartment syndrome is emergent fasciotomy (compartment release), with subsequent fracture reduction or stabilization and vascular repair, if needed. The goal of decompression is the restoration of muscle perfusion within 6 hours.

The original description of the consequences of unchecked rising intra-compartmental pressures is widely attributed to Richard von Volkmann.

In acute compartment syndrome, especially with trauma, consider performing a workup for rhabdomyolysis, with measurement of the following:

* Creatine phosphokinase (CPK)

* Renal function studies

* Urinalysis

* Urine myoglobin

Satyendra Dhar MD, 

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Lithium Toxicity

 The mechanism of action of lithium is not known. It is rapidly absorbed, has a small volume of distribution, and is excreted in the urine unchanged (there is no metabolism of lithium).

Toxic levels > 2 mEq/L

Satyendra Dhar MD,

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Statins & Recommendations

Statins & Recommendations:

Word Cholesterol came from Cholesterine, named by French chemist Michel E. Chevreul (‘solid bile’ in Greek: ‘chole’ for bile and ‘stereos’ for solid). The exact formula of cholesterol was established in 1888 by Friedrich Reinitzer. Merck Labs found the first statin, in 1978, in a fermentation broth of Aspergillus terreus, named mevinolin & later lovastatin.

Statins inhibit the critical step of cholesterol synthesis in which 3-hydroxy-3-methylglutaryl coenzyme A (HMGC) is transformed to mevalonate by the enzyme HMGC reductase. By doing so, they have a potent lipid-lowering effect that reduces cardiovascular risk and decreases mortality. Since the mevalonate pathway also influences endothelial function, the inflammatory response, and coagulation, the effects of statins reach well beyond their cholesterol-lowering properties. As with all drugs, statins may have adverse effects; these include musculoskeletal symptoms, increased risk of diabetes, and higher rates of hemorrhagic stroke. However, the frequency of adverse effects is extremely low and, in selected patient populations, the benefits of statins considerably outweigh the potential risks.

Satyendra Dhar MD, 

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SKIN RASHES

 SKIN RASHES

Skin rashes can occur from a variety of factors, including infections, heat, allergens, immune system disorders, and medications.

A rapid and accurate diagnosis is critically important to make treatment decisions, especially when mortality or significant morbidity can occur without prompt intervention.

Rashes can be divided into petechial/purpuric, erythematous, maculopapular, and vesiculobullous. After this differentiation, the presence of fever and systemic signs of illness should be assessed. Through the breakdown of rashes into these classes, emergency providers can ensure deadly conditions are considered.

Satyendra Dhar MD, 

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Nail Findings & Associated Conditions

 Nail Findings & Associated Conditions

Change in color, texture, or shape can be harmless, but may suggest an underlying systemic disease.

 • Muehrcke's Lines

 • Melanoma

 • Terry's Lines

 • Onychogryphosis

 • Clubbed Fingernails

 • Mees' lines

 • Koilonychia

 • Pterygium Unguis

 • Green Nail Syndrome

 • Leukonychia

 • Beau's Lines

 • Yellow Nail Syndrome

 • Onycholysis

 • Transverse Ridging

 • Nail Plate Crumbling

 • Nail Pitting

 • Central Nail Canal

 • Periungual Telangiectasia

 Satyendra Dhar, MD 

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LUDWIG’S ANGINA

 LUDWIG’S ANGINA

This condition was named after a German physician, Wilhelm Friedrich von Ludwig, who first described it in 1836.

Although traditionally associated with pain of cardiac origin, the term “angina” is derived from the Latin word for choke (angere) and the Greek word for strangle (ankhone). In the case of Ludwig’s angina, it refers to the feeling of strangling and choking secondary to lingual airway obstruction, which is the most serious potential complication of this condition.

Ludwig angina is a bilateral infection of the submandibular space that consists of two compartments in the floor of the mouth, the sublingual space, and the submylohyoid (also known as submaxillary) space.

Ludwig's angina usually originates from dental infections in the mandibular molars, particularly the second and third molars, accounting for over 90% of cases.

Satyendra Dhar MD, 

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