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993 posts on clinical medicine, epidemiology, research methodology, statistics and code — in English and Thai. Filter by category and language, or search.
Marked Troponin Elevation with Normal ECG: A Practical Article on Type 2 MI and Myocardial Injury
Case: “Ms. A” Ms. A presented with shoulder pain for 2 days. Her initial ECG looked normal, with no ST elevation. She did not have active chest pain at the time of reassessment and clinically looked well. However, her laboratory results were striking: Troponin I: 56 → 54 WBC: 18,000 BUN: 27 Creatinine: 0.6 CXR: normal lungs, mild cardiomegaly Serial ECG: completely normal At first glance, this creates a difficult clinical question: Is this NSTEMI, Type 2 MI, myocarditis, pulmonary embolism,...
Anaphylaxis: Emergency Diagnosis and Immediate Management (High-Yield Guide)
A) Clinical diagnosis Think anaphylaxis if acute onset (minutes to hours) after a likely trigger with: Skin/mucosal signs : urticaria, flushing, lip/tongue swelling, angioedema plus Respiratory compromise : wheeze, dyspnea, stridor, hoarseness or Circulatory compromise : hypotension, syncope, shock Also call it anaphylaxis if there is hypotension / bronchospasm / laryngeal edema after allergen exposure even without rash . B) Physical examination Focus on ABCDE Airway lip/tongue swelling →...
Alcohol Intoxication (เมาเหล้า เมาสุรา) Management: ER Approach, Red Flags, and Safe Discharge Criteria
📄 ER Order Sheet: Suspected Alcohol Intoxication 🧾 Initial Orders DTX (capillary blood glucose) – stat Vital signs monitoring Observe in ER (serial mental status + airway monitoring) 💉 Medications Thiamine 100 mg IV stat OR Vitamin B complex (containing thiamine 100 mg) IV stat 💧 IV Fluids (ONLY if indicated) 0.9% NSS 1000 mL IV Rate: 80–100 mL/hr OR adjust based on clinical status Indication: dehydration / vomiting / poor oral intake 🧪 Labs (ONLY if clinically indicated) (Do NOT send...