“Do not do” and “Do” recomendations in the elderly patient.

From SEMFYC’s “Recomendaciones no hacer y hacer en el anciano” (https://www.semfyc.es/biblioteca/recomendaciones-no-hacer-y-hacer-en-el-anciano/) The following illustration is a summary of some of things we must be aware of when treating and prescribing medication for an elderly patient. Different chronic conditions present, lots of medication and higher risk for adverse effects, much more sensibility and less glomerular filtrate,…

Management of COPD exacerbations

Patients with a chronic pulmonary obstructive disease will suffer exacerbations from time to time. It’s defined as an increase in symptoms beyond the normal day to day variability that then leads to a change in medication. It may also be defined as a worsening of the usual dyspnea, wheezing, tight chest feeling, coughing and expectoration…

Heart failure with preserved ejection fraction pathophysiology.

Also known as “diastolic heart failure”. Heart failure is one of the most important causes of dyspnea and fatigue in patients who attend to the ED with this chief complaint. Dyspnea is mostly on exertion, along with orthopnea, increased nocturia (urination at night, having to wake up) and possible progressive lower extremity edema, specially at…

Pediatrics: Viral meningitis in children.

Most feverish children who are brought to the ED may only have “tos and mocos” (coughing, rhinorrea, a common cold) and perhaps a non severe viral infection associated rash. The challenge may be identifying children who are at risk of having a bad disease, such as Meningitis. The following illustration reviews the clinical presentation of…

Lower extremity vascular disease:

Peripheral artery disease vs. deep venous thrombosis: PERIPHERAL ARTERY DISEASE (PAD).- Due to arterial stenosis. Associated with heavy and prolonged tobacco use and atherosclerotic disease. Reduce blood flow will cause signs and symptoms such as weak pulses, pallor, cold skin, ulceration and of course lower extremity pain that increases with exertion up to the point…

Thrombotic microangiopathy and hemolytic anemia:

It’s all about damage of endothelium of small vessels (micro-angio-pathy). This will cause red blood cells to “crash into” inflamed walls, break (hemolytic anemia) and trigger clot formation (thrombotic). Anemia will cause hypoxemia and then thrombosis leads to reduced and impaired blood flow, tissue hypoxia, infarction and a suggestive clinical picture: petechiae, purpura, pain, organ…

Sepsis

The patient who becomes “septic” / El paciente séptico. Quick tips: This patient looks ill and has a “toxic appearance”, mental status may be altered, looks pale or cyanotic, is hypotensive (SBP < 100), cold or feverish, breathing heavily and with very weak pulses. Skin may present livedo reticularis and capillary refill time is prolonged….

STEMI vs NSTEMI

Myocardial infarction / Infarto agudo de miocardio: The following illustration reviews the pathological and ECG differences between a myocardial infarction without and with ST segment elevation. Patients will visit the ED with chest pain compatible with angina pectoris, and will require assessment of atherosclerotic and cardiovascular disease risk. This will be reviewed in future posts….

Welcome!

My name is Augusto Saldaña. I’m a family physician and emergency physician who also enjoys drawing and teaching. In this site I’ll be posting all my illustrations used for FOAM and FOAMed. They will help you study and remember basic things about the art and science we love: Medicine. Have fun! I’m also collaborating with…