Boletín de la Asociación Médica de Puerto Rico
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This is a case of 49 year-old-female with left lower quadrant pain. Initial diagnosis of acute diverticulitis entertained and treated accordingly. ⋯ Epiploic appendagitis is commonly misdiagnosed as diverticulitis and appendicitis. Non-invasive studies may lead to early diagnosis avoiding unnecessary hospitalizations, antibiotic therapy and surgical intervention.
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This is a case of a 34 years old male Hispanic patient with history of AIDS who presented to the ER with severe right lower quadrant abdominal pain of three days of evolution, associated with fever, chills, nausea, vomiting, watery diarrhea, weakness and general malaise. Acute appendicitis, Clostridium Difficile Colitis and Ischemic Colitis were the most important clinical conditions to consider in the differential diagnosis. Abdominal CT with IV contrast demonstrated thickening of the ascending colonic wall a finding highly suggestive of a transmural inflammatory necrotizing colitis of infectious etiology. ⋯ It is important to include it in the differential diagnosis of an HIV/AIDS patient that presents with RLQ pain and fever. Contrast enhanced CT-Scan is mandatory to establish the diagnosis and to differentiate typhlitis from other intra-abdominal pathologies. Therapy needs to be individualized.
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EMTALA (Emergency Medical Treatment and Active Labor Act) is a law born during the mid-eighties as an anti-discrimination law. Initially, its intention was to protect the uninsured population from being denied medical care due to inability to pay medical bills. ⋯ EMTALA is a Federal Law that has been interpreted and adapted for its use in Puerto Rico. It is the intention of this article to describe the events that led to the Law's creation, explains how it is applied in our hospitals, and describes the implications of EMTALA in our daily practice.
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Renal stones (nephrolithiasis) are a relatively common problem and a frequent Emergency Department (ED) diagnosis in patients who present with acute flank/abdominal pain. The goal of this topic review is to provide physicians with an evidence-based diagnostic approach for the evaluation and management of patients with nephrolithiasis. ⋯ Pain management can be achieved by using NSAIDs, opioids or a combination of both. Several factors will help you determine if emergent urology evaluation is warranted; size and location of renal calculi, persistence of colic pain, impaired renal function and signs of infection.
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Sepsis is a fairly common disease process in our population. Even with aggressive treatment, morbidity and mortality remain high. The initial evaluation of these patients with sepsis, severe sepsis and septic shock may increase survival. ⋯ Recent studies have shown that with the systematic use of aggressive fluid expansion, broad-spectrum antibiotics as well as inotropes and vasopressors a decrease in mortality may be achieved. Our efforts must be geared towards a structured early diagnosis and treatment. With the right tools and approach we will be able to keep ourselves ahead of this condition in order to improve the health of our fellow patients in Puerto Rico and the rest of the world.