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Acute Management of Cervical Spine Trauma and Spinal Cord Injury

Teaser: 

Mohamed Sarraj, MD,1 Brian Drew, MD FRCSC,2

1 Division of Orthopedic Surgery, McMaster University, Hamilton, Ontario.
2 Division of Orthopedic Surgery, McMaster University, Hamilton, Ontario.

CLINICAL TOOLS

Abstract: Cervical spine injury can have life-changing consequences. At every stage of injury, we can intervene to meaningfully change patients' outcomes. On the field, a high index of suspicion is critical. Spinal immobilization prevents secondary injury, but immobilization, particularly use of a hard board, must be kept to a minimum. In the trauma bay, perfusion of the spinal cord is a priority to help prevent secondary spinal cord injury. This means addressing any cause of hypotension and understanding how to manage neurogenic shock. In the spinal-cord injured patient, hemodynamic management is an important adjunct.
Key Words:Spinal Cord Injury; Trauma; Cervical; Ankylosing Spondylitis.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

Pre-test CME Quiz Post-test CME Quiz
1. Minimize time in rigid immobilization as much as feasible.
2. Spinal shock is temporary flaccid paralysis and loss of reflexes. You cannot give a prognosis for a spinal cord-injured patient in spinal shock.
3. Recognize patients with stiff spines (such as in ankylosing spondylitis) and immobilize them in their natural position of comfort to avoid secondary injury.
4. What we can do to improve neurologic outcomes in spinal cord injury: Maintain spinal cord perfusion through oxygenation and blood pressure management, avoid secondary injury through immobilization, and facilitate early surgical decompression (<24hr)
1. The Canadian C-spine Rule is the preferred algorithm to clear the cervical spine after trauma.
2. X-rays are not sufficient to rule out cervical spine injury. CT scan is the gold standard.
3. Neurogenic shock is a distributive syndrome characterized by the triad of hypotension, bradycardia, and peripheral vasodilation. First line treatment is fluid resuscitation, then vasopressors.
4. Patients with stiff spines (ankylosing spondylitis or DISH) have high rates of spine fractures and non-contiguous injuries. Full spine CT scans should be obtained.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Back Health, spinal cord injury, trauma, cervical, ankylosing spondylitis

Be Careful What You Write

Teaser: 

While studying medicine, I recall being told the importance of careful and accurate documentation. This was long prior to the introduction of the electronic health record.

Related Terms: Medical Narratives
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#26: Approach to Fatty Liver

Welcome to 3P: Pills, Pearls, and Patients where we will discuss current events in medicine, stories from real patient-physician encounters, and gain insight into what it's like being a physician in today's society.

Please note that while the first episode is available to listen to without registration, accessing additional episodes will require you to subscribe and log in.

  Back to Pills, Pearls & Patients (3P)

 

Hello and welcome to the next episode of 3P, Pills, Pearls and Patients. I'm your host, Dr. Marina Malak. And today's episode is on Approach to Fatty Liver.
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4 applauses

Dr. Marina Malak is a family physician in Mississauga, Ontario and a lecturer and faculty member at the University of Toronto. She is actively involved in medical advocacy, and is a board member of the Mississauga Primary Care Network. She is also a member of the National Committee of Continuing Professional Development at the College of Family Physicians of Ontario, and a member of the Research Ethics Board at Trillium Health Partners.

She is passionate about patient care; medical education; and promoting mental, physical, and emotional wellness. She enjoys reading, writing, public speaking, puzzles, doodling in her bullet journal, and creating drawings on Procreate.

Pediatric Warts: 2023 Update

Teaser: 

Mahan Maazi, MEng,1 Joseph M. Lam, MD, FRCPC,2

1 Faculty of Medicine, University of British Columbia.
2Department of Pediatrics, Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada.

CLINICAL TOOLS

Abstract: Cutaneous warts or verruca are benign growths of the skin that affect 30 to 70% of school-age children and has a lifetime prevalence of 10 to 22% in children. It is caused by human papillomavirus (HPV) which spreads from skin-to-skin contact or fomites and infects squamous cell in areas like the hands and feet. There are different HPV subtypes that cause different types of warts including common warts (verruca vulgaris), plantar warts (verruca plantaris), flat warts (verruca plana), mosaic warts, filiform/digitate warts, epidermodysplasia verruciformis, and condyloma acuminata (genital or venereal warts). Most warts will spontaneously clear within 2 years. Diagnosis is based on history and physical examination features which may include dermoscopy and rarely, histological confirmation. Management includes treatment with topical salicylic acid and cryotherapy, the two most common and effective modalities.
Key Words: warts (verruca), human papillomavirus (HPV), common warts (verruca vulgaris), plantar warts (verruca plantaris), flat warts (verruca plana), mosaic warts, filiform/digitate warts, epidermodysplasia verruciformis (EV), condyloma acuminata (genital or venereal warts).
Cutaneous warts are a benign growth caused by human papillomavirus (HPV) infection that can cause discomfort. These are most common in school-aged children and in adolescents.
HPV infection is acquired through skin-to-skin contact, contact with fomites, or through maternal transmission during birth. The virus infects squamous cells on the skin and inserts its viral genome into the cells causing survival and proliferation of the virus.
History and physical examination help diagnose warts in children. Dermoscopy and histology may also aid in diagnosis, especially in more challenging presentations. A history of genital warts in children mandates ruling out sexual abuse.
There is a wide range of treatment modalities that can be used for warts. The most well-studied are destructive therapies such as salicylic acid and cryotherapy. There are side effects from treatments such as pain, blistering, scarring and dyspigmentation from cryotherapy. HPV vaccination in children is useful in preventing certain subtypes of genital warts and those that may cause cancer.
Warts often spontaneously resolve with 33% clearing within the first 6 months, 66% within the first 2 years, and 90% within the first 5 years.
Treatment can hasten resolution of warts and often involve destructive therapies such as salicylic acid and cryotherapy.
HPV subtypes causing cancer are rare. Vaccination can significantly decrease the chance of acquiring HPV subtypes that cause genital warts and cervical, anal, oropharyngeal, penile, vulvar, and vaginal cancer.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Dermatology, warts, common warts, plantar warts, flat warts, mosaic warts, filiform/digitate warts, epidermodysplasia verruciformis, condyloma acuminata
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Prostate Cancer Imaging: Ultrasound, CT, MRI, and Nuclear Medicine Techniques

Teaser: 

D'Arcy Little MD CCFP FCFP FRCPC,

Radiologist, Orillia Soldiers' Memorial Hospital, Adjunct Clinical Lecturer, Department of Family and Community Medicine and Department of Medical Imaging, University of Toronto, Toronto, ON.

CLINICAL TOOLS

Abstract: Prostate cancer is a common cancer in men worldwide, and early detection is key to improved patient outcomes. Diagnosis typically involves a combination of clinical examination, prostate-specific antigen blood testing, and imaging studies. Radiology plays an important role, aiding in treatment planning, confirming the diagnosis by directing biopsy, staging the patient, and following treatment course. Imaging modalities for prostate cancer diagnosis include ultrasound, CT, nuclear medicine, and MRI. While MRI is the most sensitive imaging modality, ultrasound is still the preferred modality for measuring the prostate volume. Prostate-specific membrane antigen PET imaging has shown to have superior sensitivity and specificity compared to conventional imaging modalities in the detection of prostate cancer, especially in the context of low PSA. Clinical pearls include performing ultrasound-guided biopsy under local anesthesia to improve patient comfort, and the use of fusion MRI and ultrasound images to facilitate MRI/TRUS fusion-guided biopsy.
Key Words: Prostate cancer, imaging modalities, ultrasound, MRI, CT, PSMA PET.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

Pre-test CME Quiz Post-test CME Quiz
Radiology plays a crucial role in prostate cancer diagnosis, aiding in treatment planning, confirming the diagnosis, and directing biopsy.
Imaging modalities for prostate cancer diagnosis include ultrasound, CT, nuclear medicine, and MRI.
MRI is the most sensitive conventional imaging modality for detecting prostate cancer.
Prostate-specific membrane antigen PET imaging has been shown to have superior sensitivity and specificity compared to conventional imaging modalities in the detection of prostate cancer, especially in context of low PSA.
Ultrasound is still the preferred modality for measuring the prostate volume.
Ultrasound-guided biopsy is a minimally-invasive procedure that involves inserting a needle through the rectum via an ultrasound probe guide and into the prostate gland. It is performed under local anesthesia and patients are discharged the same day after a short period of observation in the radiology department.
MRI and ultrasound images can be fused to facilitate MRI/TRUS fusion-guided biopsy, which improves the accuracy of the biopsy procedure.
The use of antibiotic prophylaxis before ultrasound-guided biopsy decreases the risk of infection to approximately 1 in 100 patients.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Urogenital Disorders, prostate cancer, imaging modalities, ultrasound, CT, MRI, PSMA, PET
Disclaimer: 
Disclaimer at the end of each page

Music and the Mind

Teaser: 

Music is wonderful. It is universally loved by the most sophisticated and what are often referred to as less-sophisticated peoples.

Related Terms: Medical Narratives
Disclaimer: 
Disclaimer at the end of each page

#25: Owning Osteoporosis: Part 2

Welcome to 3P: Pills, Pearls, and Patients where we will discuss current events in medicine, stories from real patient-physician encounters, and gain insight into what it's like being a physician in today's society.

Please note that while the first episode is available to listen to without registration, accessing additional episodes will require you to subscribe and log in.

  Back to Pills, Pearls & Patients (3P)

 

Hello and welcome to the next episode of 3P, Pills, Pearls and Patients. Today is Owning Osteoporosis: Part 2. So if you have not listened to Owning Osteoporosis: Part 1, I strongly recommend that you listen to that. As this is a follow-up to that episode.
...

 

1

4 applauses

Dr. Marina Malak is a family physician in Mississauga, Ontario and a lecturer and faculty member at the University of Toronto. She is actively involved in medical advocacy, and is a board member of the Mississauga Primary Care Network. She is also a member of the National Committee of Continuing Professional Development at the College of Family Physicians of Ontario, and a member of the Research Ethics Board at Trillium Health Partners.

She is passionate about patient care; medical education; and promoting mental, physical, and emotional wellness. She enjoys reading, writing, public speaking, puzzles, doodling in her bullet journal, and creating drawings on Procreate.

‘Walk-in Physicians vs. Primary Care Physicians: The same or different?’

Teaser: 

Dr. Marina Abdel Malak, MD, CCFP,

is a Family Physician in Mississauga, Ontario. She has served on several committees and groups, including The Primary Care Network and Collaborative Mental Health Network. She has a passion for medical education, patient empowerment, and increasing awareness about the relationship between mental, emotional, and physical health. Dr. Abdel Malak is highly involved in quality improvement initiatives, and her research interests include strategies to support physician wellness, patient self-management, and optimizing physician education.

CLINICAL TOOLS

Abstract: Family physicians may work in walk-in clinics (WICs), or choose to follow their patients as a family practice, also known as primary care (PCP). In some cases, there are differences between the roles of both physicians: generally WICs are seen as being for urgent issues, whereas primary care is seen as dealing with chronic conditions. However, with the rise in patients without family physicians, many have had to rely solely on WICs for their ongoing care. This article explores the differences—and similarities—between both models, and suggests some strategies for navigating any disparities.
Key Words: walk-in physicians, primary care physicians.
WICs and PCPs both help patients with health concerns, but usually WICs are reserved (ideally) for urgent concerns
Patients should be encouraged to develop a relationship with a PCP so as to ensure long-term care and chronic conditions are managed
Strategic and focussed resource allocation will allow our family physicians to properly care for populations, regardless of what model they practice in
WICs are usually – and ideally – reserved for urgent care issues
Primary care is focussed on health promotion and illness prevention
Ideally, long-term relationships among physicians and patients should be established so as to maintain a high standard of care
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Caregiving
Disclaimer: 
Disclaimer at the end of each page