HAP28 - rash - only really covers erythroderma!  Erythroderma is skin redness over lots of the body. It could be caused by anything but is really itchy. You need emollients, consider steroids and discuss with dermatology.  Idiopathic erythroderma is is sometimes called 'the red man syndrome'. ✓Generalized erythema and edema affects 90% or more of the skin surface. ✓Warm and itchy skin noted ✓Eyelid swelling may result in ectropion. ✓scaling begins 2 to 6 days after onset of a erythema. pic.twitter.com/QgzwUr4skB — ERresidentsquad (@Erresidentsquad) January 5, 2021 Psoriatic ..read more

 These guidelines from NHS England are excellent and cover triage, METHANE, blast injury and more. They say everything you need to know in one document - read them.  End of Post ..read more

 Portal vein problems might be caused by portal hypertension - cirrhosis, malignancy or hypercoagulable - prothrombotic conditions, malignancy, oral contraceptive pill, pregnancy, trauma.  Portal vein thrombosis may present with many things including abdominal pain, nausea and fever, variceal bleeding, and encephalopathy - or be completely asymptomatic.   Treatment includes observation, anticoagulation, thrombectomy and shunts. Need to prevent thrombus extension and mesenteric ischaemia. May present as an acute ischaemic bowel.  Referenceshttps://www.gpnotebook.com/si ..read more

  Renal vein thrombosis in adults is normally triggered by infection (glomerulonephritis, renal sepsis), amyloidosis, SLE, diabetes, urinary obstruction, tumour thrombus.  The passive congestion causes the kidney to swell and become engorged and nephrons degenerate causing flank pain, haematuria and decreased urine output.  Treat by treating cause, and anticoagulation therapy.  Referenceshttps://radiopaedia.org/articles/renal-vein-thrombosis https://pubmed.ncbi.nlm.nih.gov/30725656 ..read more

  Mostly from non UK sources, with incubation 5-30 days, but maybe up to 6 months. Comes from unpasteurised dairy products - eating or inhaling airborne components. Take a thorough travel history.  Previously called Maltese fever.  PresentationMay be asymptomatic.  Fever (74%)  may wax and wane Constitutional  (26%) - fever, malaise, weakness, fatigue, headache, dizziness, myalgia, arthralgia and night sweats.  Hepatomegaly and splenomegaly (33%) Maloderous perspiration - almost pathognomic Peripheral neuropathy, pleural effusions, pneumonia and endocarditis ..read more

Pain management is something we're really bad at doing, and even worse at documenting! Assessment Use a pain scale, or a pain ruler Remember that pain has an emotional as well as physical component. When you catch your thumb in a door you shake it and look at it. If it does not bleed too much but still wiggles and the pain goes quickly, then that is mostly "red" - physical. However the longer a pain lasts the more the emotional component becomes part of the problem. The emotional component is made up of three aspects. There is anxiety and worry and typically we worry about two things. We wo ..read more

Awake and Conscious Patient  Assess symptoms: With the temperature dropping recently I thought it might be a good time to retweet the first infographic from my #infographic challenge. Hypothermia, the correlation of core temperature and physiological changes. I hope it's useful. More at https://t.co/Bvm7MMLro2 #FOAMed pic.twitter.com/udjKgDuPlE — Strata5 (@Nrtaylor101) November 20, 2019 Investigations: Put the temperature on the gas machine Look for J waves (osborn). The upward deflection of the terminal S wave (at the junction of the QRS and the ST segment) occurs at or near 32 C. It is firs ..read more

BNP is produced by cardiac myocytes in response to stretch which occurs in impaired diastolic or systolic function. BNP may play an important role in acute cardiac failure. BNP assays can supplement clinical judgment when the cause of a patients dyspnoea is uncertain. Results should be interpreted in the context of all available clinical data. The role of BNP in chronic heart failure is, however, well established for diagnosing, staging and risk stratifying patients. BNP has reasonable sensitivity and therefore can be used to rule out heart failure as a cause of a patients breathlessness (in ..read more

Clinical Features Coffee is protective against gout, but intense exercise and microtrauma can precipitate For rheumatoid rather than reactive, symptoms must be >8 weeks. Ask about skin (ank spond linked to psoriasis), butterfly rash in the heat (SLE), morning stiffness (RA has atleast an hour), diarrhoea, blood, eye signs, miscarriages If it's 1st MTP - gout most likely There can be RA accelerated atherosclerosis Examination Red, hot, shiny joint is likely to be gout 95% of nodules are gout or RA. Investigations 10-40% have a normal urate during flares Treatment NSAIDs - topical or oral ..read more