Clinical Skills and PBL Muse #27: Going on vacation

Going on vacation may be more than just a pleasure. It may actually be good for all aspects of your health . . .

Dr. Maynard Luterman

Clinical Skills Muse #26: Breast cancer detection

Click here for a 2004 position statement from the National Breast Cancer Centre on early detection of breast cancer, courtesy of Dr. Luterman.

PBL Muse #26: What makes a good teacher?

Click here for a two-page commentary on important principles of good teaching.

Clinical Skills Muse #25: Transfusions Part 2 -- Clinical Signs

So last week we talked about the different types of transfusion reactions...this week can you describe what the patient will complain of (history) and what physical findings you may find if the patient is having a reaction (physical findings)?

Click here for the original article.

History

In hemolytic transfusion reactions, symptoms usually occur after a small amount of blood has been transfused and almost always before the unit is transfused completely. These reactions are associated with the following:
-Fever
-Chills
-Flushing
-Nausea
-Burning at the intravenous (IV) line site
-Chest tightness
-Restlessness
-Apprehension
-Joint pain
-Back pain

Nonhemolytic febrile reactions do not occur as rapidly as acute hemolytic reactions. They occur between 1 and 6 hours of transfusions and are associated with the nonspecific symptoms of fever, chills, and malaise. Some patients may complain of dyspnea. These nonspecific symptoms also occur with a hemolytic transfusion reaction.

In anaphylactic reaction, symptoms usually occur with less than 10 mL of blood transfused and only rarely occur more insidiously. These reactions are associated with rapid development of the following:
-Chills
-Abdominal cramps
-Dyspnea
-Vomiting
-Diarrhea

Minor allergic reactions are associated with urticaria.

Extravascular hemolytic reactions are associated with fever and chills. Symptoms often occur after several hours and sometimes may be observed several days after transfusion.

Symptoms of transfusion-related acute lung injury start suddenly while the blood products are being transfused or shortly thereafter. Dyspnea is the primary presenting symptom.

Graft-versus-host disease often presents within the first week following transfusion, although it may be delayed up to several weeks following transfusion. Symptoms include the following:
-Fever
-Abdominal pain
-Nausea
-Vomiting
-Diarrhea, often copious
-Anorexia

Hypocalcemia from multiple transfusions may present with circumoral tingling and tremors of the skeletal muscles.

Physical

Hemolytic transfusion reactions are associated with the following signs, which usually occur after a small amount of blood has been transfused and almost always before the unit is transfused completely:
-Tachycardia
-Tachypnea
-In severe cases, hypotension, oozing from the IV site, diffuse bleeding, hemoglobinuria, and shock
-Oliguria may be seen in renal failure.

(IMPORTANT) In unconscious or obtunded patients, the diagnosis of hemolysis is suggested by development of the following:
-Hypotension
-Dark urine
-Oozing from an IV or other puncture sites

Nonhemolytic febrile reactions are associated with a fever.

Anaphylactic reactions are associated with the following:
-Tachycardia
-Flushing
-Urticaria
-In more severe cases, wheezing, laryngeal edema, and hypotension

Minor allergic reactions are associated with urticaria.

Extravascular hemolytic reactions are associated with fever. Only rarely are signs of shock and renal failure noted. Clinical signs may occur several days later.

Patients with transfusion-related acute lung injury will present with the following signs:
-Fever
-Tachycardia
-Tachypnea
-Rales

Graft-versus-host disease often presents with the following signs:
-Erythematous, maculopapular rash, which may progress to toxic epidermal necrolysis Right upper quadrant tenderness
-Hepatomegaly

Again, here is the full article.

Maynard

PBL Muse #25: Habits of Highly Effective Teachers

This week’s PBL muse is about the 7 traits that highly effective teachers should have.....truth is, the reviews on the Niagara Campus teachers by our students has been superlative....keep up the great work....we are shaping some brilliant new medical minds.

Click here for the list of traits.

Maynard