Evaluation of a case pseudogout with diabetes and cardiomegaly

A 43-year-old man with diabetes and cardiomegaly has had an attack of pseudogout. He should be evaluated for which of the following?

• a.Renal disease
• b.Hemochromatosis
• c.Peptic ulcer disease
• d.Lyme disease
• e.Inflammatory bowel disease

The answer is b.

Calcium Pyrophosphate Crystals

Pseudogout is part of the spectrum of calcium pyrophosphate deposition disease. It is usually an acute monoarthritis or oligoarthritis caused by calcium pyrophosphate crystals in the joint. Pseudogout may be associated with hemochromatosis. Since the patient has a history of diabetes mellitus and cardiomyopathy, hemochromatosis must be considered. Serum iron saturation should be measured. Ferritin may also be a useful measure of iron stores. Pseudogout has also been associated with hyperparathyroidism. A familial form of the disease has been localized to chromosomes 8q and 5p. Inflammatory bowel disease, Lyme disease, and peptic ulcer disease do not predispose to pseudogout.

Ortho Instruments & Function

About Opioids In a multi-trauma patient with a head injury

 In a multi-trauma patient with a head injury, opioids ;

• a)can be used to treat severe pain
• b)cannot be given to a ventilated patient
• c)can be given intramuscularly (IM) in the general ward
• d)will cause a change to ICP in a ventilated patient whose blood pressure remains constant
• e)will require the use of supplemental oxygen

 T F F F T

A multi-trauma patient with a head injury is likely to be in severe pain. Pain can increase ICP, therefore it is not only humane to treat the patient it is intracranially beneficial. However if opioids can be avoided by the use of nerve blocks this should be done. If not suitable, then small intravenous doses of an opioid can be used with the patient’s neurological status closely monitored in an intensive care or high dependency environment.

In patients who are being ventilated, it is quite safe to use opioids. Provided blood pressure does not fall, there is no change in ICP. If BP falls, autoregulation induces cerebral arterial vasodilatation, which, in a decompensated state, will raise ICP. A patient who is breathing spontaneously, may also have a fall in arterial saturation. This would exacerbate the effects of a rising CO.
Supplemental O2 should be given whenever possible to reduce the risk of hypoxia, known to occur when a patient is under the effect of an opioid falls asleep.

Proposed decision tree for the management of epiglottitis

The main consideration in management is airway maintenance. Patients without signs and symptoms of airway obstruction can be treated medically in a hospital unit with equipments and personnel available for airway management if required.
A second or third generation cephalosporin is the most effective antibiotic against beta lactamase producing organisms and should be considered as initial antibiotic therapy. Simultaneous treatment of the underlying condition is mandatory. Corticisteroids have not proven in a prospective randomized trial to reduce the need for airway intervention or hasten recovery in adult acute epiglottitis.
This algorithm shows the proposed decision tree for the management of epiglottitis.

 Click her for enlargement