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Ask a Librarian!—November 2011

, November 17, 2011

This month's topics include the evidence pyramid--how certain types of studies offer more rigorous evidence than others--and resources for PAs interested in OB/GYN topics.
 

Electrolyte abnormalities on ECG

, November 16, 2011

The authors review the characteristic changes that hypercalcemia, hyperkalemia, hypokalemia, and other serum electrolyte abnormalities can cause on an ECG.
 

Fusobacterium otitis causes a case of 
hydrocephalus and fatal meningitis

Erin N. Arrington; M. Michael Behnia, MD November 15, 2011

A delay in the administration of antimicrobial therapy resulted in lethal complications. To reduce the high morbidity and mortality rates, clinicians must begin early treatment.
 

Ventricular fibrillation

, October 14, 2011

An unsteady baseline and a very irregular QRS segment are highly indicative of ventricular fibrillation.
 

Abdominal pain in an elderly patient with an extensive surgical history

, Sonia James, RN, MA, ACNP-BC, CCRN October 10, 2011

One of the first steps to diagnosis was ruling out ischemia due to an earlier surgical procedure. CT with and without contrast helped confirm the cause of this man's worsening discomfort.
 

Finding hope in Haiti

September 19, 2011

During a trip to Haiti last spring, I felt an emotion I wasn't expecting to feel: hope.
 

Ventricular tachycardias

, James F. Ginter, MPAS, PA-C September 14, 2011

Whether patients have symptoms depends on how well the tachycardia is perfusing vital organs.
 

Immune (idiopathic) thrombocytopenic purpura in a 21-year-old student

, September 12, 2011

Diagnosis of the adult form and the pediatric form of ITP may be based less on the calendar than on individual patient presentation.
 

Surgical treatment for osteochondral injuries of the articular knee surface

September 05, 2011

Techniques involving the transfer of osteochondral cylinders and implanting of cartilage cells in areas of damaged cartilage can reduce patients' pain and return them to an active lifestyle.
 

Atrial tachycardia

, August 12, 2011

In a patient with a rapid heart rate, measuring the width of the QRS complex can provide an important diagnostic clue.
 

Animal-assisted therapy: Do patients experience a medical benefit?

August 01, 2011

Statistically significant changes are not often seen in studies, but patients report feeling better after interaction with an animal and that alone should justify the use of animal-assisted therapy.
 

An adolescent hockey player suffers a rare injury in an uncommon location

August 01, 2011

Various radiographic views found no injury, but limited range of motion and pain persisted.
 

Progressive weakness and inability to walk in a healthy 28-year-old male

July 11, 2011

The weakness was so severe that the patient could not get out of bed despite having intact sensation in his feet, and friends had to help transport him to the emergency department.
 

Serum anion gap: An important tool in patients with acid-base disorders

, Divya Rajan, MD; Alluru S. Reddi, MD, PhD July 01, 2011

Calculation of serum anion gap produces a useful tool for classifying metabolic acidosis, even though no actual gap exists in the normal physiologic state.
 

An effective tool in establishing the diagnosis of sport-related concussion

Jonathan Thomas Baird, MPAS, PA-C, ATC June 20, 2011

An objective assessment of concussion will benefit the athlete as well as aid clinicians in 
accurately describing the injury to parents, coaches, and the athletes themselves.
 

Transverse myelopathy mimicking conus medullaris syndrome

, Michael Roscoe, PhD, MPAS, PA-C June 07, 2011

A generally healthy man with a history of migraine headaches and diplopia awakens with sudden onset of numbness below the waist, erectile dysfunction, and difficulty urinating.
 

Managing your digital footprints: How to use social media intelligently

PPC, the Professional Practice Council of the AAPA May 13, 2011

As the use of social media increases and communication boundaries blur, PAs should understand what information can be shared online.
 

An atypical case of ARB-associated angioedema of the small intestine

, May 09, 2011

A patient with a history of hypertension and myasthenia gravis reports worsening bouts of nausea, vomiting, and diarrhea.
 

Intermittent headaches relieved by lying down

, Mark Casteel, MD; Peter White, MD April 29, 2011

The patient was growing depressed that attempts at pain relief, including therapy for migraine headache and chiropractic care, failed to relieve her month-long symptoms.
 

Acute peroneal tendon tear: Extreme pain indicative of more than a sprain

April 11, 2011

The patient's injury was diagnosed as an ankle sprain, but worsening pain and MRI findings indicated a more serious diagnosis.
 

Ask a Librarian!—April 2011

, April 07, 2011

This month's topics are online sources for evidence-based practice and comparing UpToDate and DynaMed.
 

Dengue fever: Potentially fatal, and now emerging in the United States

March 28, 2011

Long thought to be endemic only in other parts of the world, dengue is the focus of an 
investigation in Key West, Florida, site of a recent outbreak.
 

Does genetic screening reduce adverse 
effects when initiating warfarin therapy?

March 24, 2011

Although data show a correlation between using a pharmacogenetic algorithm and shorter times to a stable warfarin dose and more time spent in the therapeutic range, it is unclear whether these factors cause a significant decrease in adverse clinical events.
 

Imaging the appendix

March 16, 2011

The laying on of hands is essential to learning the art of medicine. If clinicians do not practice this art, how can they hope to become skilled diagnosticians?
 

Miller Fisher variant of Guillain-Barré syndrome in an HIV-infected patient

, Miguel Valdes-Sueiras, MD; Pam Jongthavorn, NP; Shilpa Sayana, MD; Homayoon Khanlou, MD March 07, 2011

Symptom overlap makes Miller Fisher syndrome hard to distinguish, but the presence of antiganglioside antibodies can verify a diagnosis.
 

The devil made me do it: Opposing views of social media

February 25, 2011

Two recent pieces that came to my attention do a great job at highlighting the different camps among medical providers using social media. My sense is that there is a pretty even split between providers suspicious of social media and providers who see upside in the endless possibilities it presents.
 

Swelling of the eye and light sensitivity in a patient struck in the face by a wakeboard

, Michael Suprenant; Barbara Piccirillo, MS, RPA-C, DFAAPA February 25, 2011

The patient brushed off the mishap until friends noted ocular swelling and drooping of the right eyelid.
 

Atypical femoral stress fracture in a woman on alendronate therapy

February 07, 2011

Both the patient's bone mineral density and fracture risk assessment were improving when she noted intensifying pain in her left thigh.
 

Where's the beef? Does the evidence support the claims of benefits of EMRs?

February 04, 2011

Both the popular and scientific press are packed with estimations of the benefits of EMRs. But what does the evidence say to support such claims?
 

The perfect circle

February 01, 2011

Most of the PAs I talked to saw the value of having PAs involved in the IT and EMR side. The conversations sharpened my belief that the move to the IT side was right for me, and that in fact it might be right for some colleagues as well.
 

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