Make Sure-eMediNews:Health & Medicine Updates

Sunday, May 26, 2013 | Updated 0:56 IST

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Situation: A patient on amlodipine developed severe gum hypertrophy.

Reaction: Oh my God! Why was amlodipine not stopped? Lesson: Make sure that all patients on amlodipine are watched for gum hypertrophy as its side effect.More...

Situation: An 18-year-old girl complained of purulent nasal discharge, nasal congestion, pain in the

Reaction: Remember to give macrolides. Lesson: Make sure to remember that clarithromycin 500 mg twice-daily for 7 days is not only effective in maxillary sinusitis but also in other sinusitis.
More...

Situation: A 42–year–old male developed acute heart attack after playing squash.

Reaction: Oh my God! Why did he not get a cardiac check up done yet? Lesson: Make sure that after the age of 40 anybody going for anaerobic games should first get a cardiac clearance.
More...

Situation: A patient with fever and cough developed complications after he was given antibiotics.

Reaction: Oh my God! What was the need of giving the antibiotics? Lesson: Make sure that a patient with fever and cough is not given antibiotics as presence of cough mostly signifies viral infection.
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Other Make Sure Article

Situation: A patient with LBBB in ECG developed acute pulmonary edema.
Reaction: Oh my God! Why was the underlying low cardiac functions not suspected? Lesson: Make sure all patients with LBBB undergo echo to rule out ejection fraction. This may not be true for RBBB.More »

Situation: A patient with acute heart attack died on the way to the hospital.
Reaction: Oh my God! Why was the patient not accompanied by the doctor? Lesson: Make sure that all heart attack patients are accompanied by the doctor to the hospital so that chest compression CPR can be given, if the heart stops, on the way.More »

Situation: A patient developed dangerous arrhythmias in the immediate post CABG procedure.
Reaction: Oh my God! Why did you not correct his K+ value of 3.4 pre–operatively? Lesson: Make Sure that pre–operative K+ value of <3.5 is corrected. Cardiac surgery patients who have serum potassium levels below 3.5 mmol/L are at high risk for perioperative arrhythmia.More »

Situation: In an STD clinic, a 23–year–old heterosexual male presenting with dysuria and uretheral d
Reaction: Oh my God! Why didn’t you advise the same treatment to his partner also? Lesson: Make sure to remember that it is essential to treat both partners in such cases.More »

Situation: A patient with suspected heart attack with blood pressure of 40 mmHg with warm peripherie
Reaction: Oh my God! Why was a diagnosis of anaphylaxis not considered? Lesson: Make sure all patients with warm shock are managed on the lines of sepsis or anaphylaxis. Heart attack will present as cold shock.More »

Situation: A patient with dengue fever developed shock.
Reaction: Oh my God! Why was the blood pressure 90/80 ignored? Lesson: Make sure that a pulse pressure of less than 20 is not ignored, it is an impending sign that the patient is going into shock.More »

Situation: A patient on amlodipine developed severe gum hypertrophy.
Reaction: Oh my God! Why was amlodipine not stopped? Lesson: Make sure that all patients on amlodipine are watched for gum hypertrophy as its side effect.More »

Situation: A patient after sublingual nitrate developed fainting attack.
Reaction: Oh my God! Why was the systolic murmur missed on auscultation? Lesson: Make sure that patient with left ventricular outflow tract (LVOT) obstruction are not given sublingual nitrates.More »

Situation: A patient on ACE inhibitor developed angioedema.
Reaction: Oh my God! Why was ACE inhibitor continued? Lesson: Make sure that patients on ACE inhibitors are advised to watch for symptoms of urticaria and stop the drug immediately in case swelling of lip, face or tongue develops (Br J Clin Pharmacol 1999;48(6):861–5).More »

Situation: A patient died after receiving penicillin injection.
Reaction: Oh my God! Why was anaphylaxis not suspected? Lesson: Make sure that each time a patient is given penicillin injection, anti anaphylaxis measures are available.More »

Situation: A patient with dengue died.
Reaction: Oh my God, why was he not given adequate fluids? Lesson: Make Sure that all patients with dengue are given fluids to correct intravascular dehydration.More »

Situation: A dengue patient with BP 100/90 developed shock.
Reaction: Oh my God! Why was rapid fluid challenge not given? Lesson: Make sure that pulse pressure (upper minus lower blood pressure) is maintained above 40 in all patients with dengueMore »

Situation: A patient was brought to the ICU in cardiogenic shock.
Reaction: Oh my God! Why didn’t you take him for emergency angiography and subsequent PTCA? Lesson: Make Sure to perform an emergency diagnostic angiography and mechanical revascularization with PTCA in patients of cardiogenic shock. Results of NRMI–2 suggest that this intervention is much better than thrombolytic therapy in such patients.More »

Situation: A female patient complained of lower abdominal pain, fever and had uterine tenderness on
Reaction: Oh my God! You should do cervical swabs and consider starting antibiotics. Lesson: Make sure to remember that women with such symptoms may have endometritis, which requires prompt diagnosis. It may respond to doxycycline and metronidazole.More »

Situation: A patient on 10 units of insulin developed hypoglycemia with 11 units of insulin.
Reaction: Oh by God! Why was additional insulin given? Lesson: Make sure that the insulin dose is correctly calculated. The formula is 1500/total daily dose. The value will be the amount of sugar fluctuation with one unit of insulin.More »

Situation: A patient with rheumatic arthritis was not given penicillin prophylaxis, and subsequently
Reaction: Oh my God! Why was the prophylaxis not started? Lesson: Make sure that one administers secondary prophylaxis in the setting of suspected poststreptococcal reactive arthritis for up to one year after the onset of symptoms. Evidence of valvular disease after one year should prompt continued prophylaxis; otherwise, antibiotic prophylaxis may be discontinued.More »

Situation: A patient on 10 units of insulin developed hypoglycemia after taking a light breakfast.
Reaction: Oh my God! Why was the insulin dose not reduced? Lesson: Make sure that insulin dose is correct. The formula is 500/total daily dose. The value will be the amount of sugar fluctuation with 10 gms of carbohydrates.More »

Situation: A foreigner with a single loose stool developed sepsis.
Reaction: Oh my God! Why were antibiotics not started in time? Lesson: Make sure that all foreigners are diagnosed to be suffering from Traveler’s diarrhea even if there is one single loose motion.More »

Situation: A patient with acute chest pain died before reaching the hospital
Reaction: Oh my God! Why was water–soluble aspirin not given? Lesson: Make sure that at the onset of acute heart attack and chest pain, water–soluble aspirin is chewed to reduce chances of sudden death.More »

Situation: An adult undergoing bronchoscopic biopsy developed infective endocarditis.
Reaction: Oh my God! Why was IE prophylaxis not given?Lesson: Make sure, that all procedures of the respiratory tract that involve incision or biopsy of the respiratory mucosa include IE prophylaxis.More »

Situation: A neonate in an ICU being administered IV calcium exhibits signs of inflammation and necr
Reaction: Oh my God! Why didn’t you observe the IV site carefully. Lesson: Make Sure that all hypocalcemic neonates are put on a cardiac monitor while receiving calcium infusions and the IV site is closely observed, because extravasation of calcium can produce severe interstitial necrosis.More »

Situation: A patient with prosthetic heart valves (bioprosthetic) developed infective endocarditis.
Reaction: Oh my God! Why was he not given infective endocarditis prophylaxis?Lesson: Make sure that all patients with prosthetic heart valves (bioprosthetic or homograft) are given infective endocarditis prophylaxis.More »

Situation: A 4–year–old girl with rickets is unresponsive to high doses of vitamin D.
Reaction: Oh my God! Why didn’t you advise alfacalcidol? Lesson: Make sure to advise alfacalcidol in patients unresponsive to calcium/vitamin D therapy. Alfacalcidol, in numerous studies, has been found to be effective in refractory cases of rickets.More »

Situation: A patient was brought to the ICU in cardiogenic shock.
Reaction: Oh my God! Why didn’t you take him for emergency angiography and subsequent PTCA. Lesson: Make Sure to perform an emergency diagnostic angiography and mechanical revascularization with PTCA in patients of cardiogenic shock. Results of NRMI–2, an ongoing trial suggest that this intervention is much better than thrombolytic therapy in such patients.More »

Situation: The patient missed her last dose of hepatitis B vaccine as she was out of station at 6th
Reaction: Oh my God! Why was the vaccine not given between 4–6 months. Lesson: Make sure that all patients are given the complete vaccine regimen. The correct regimen is 0, 1–2 months and 4–months.More »

Situation: A patient’s blood pressure was not responding to Arkamin.
Reaction: Oh my God! Why was the patient given Artamin?Lesson: Make sure that prescription is written with the drug name spelled clearly.More »

Situation: A neonate in an ICU being administered IV calcium exhibits signs of inflammation and necr
Reaction: Oh my God! Why didn’t you observe the IV site carefully. Lasson: Make Sure that all hypocalcemic neonates are put on a cardiac monitor while receiving calcium infusions and the IV site is closely observed, because extravasation of calcium can produce severe interstitial necrosis.More »

Situation: A patient with acid peptic disease was denied any painkiller for his distressing illness.
Reaction: Oh, my God! Why did you not give him nimesulide? Lasson: Make sure to prescribe nimesulide as it is safe in acid peptic disease.More »

Situation: A patient with diabetes shows deteriorating kidney function.
Reaction: Oh my God! His HbA1C is very high? Lesson: Make sure that strict glycemic control is maintained in patients with type 2 diabetes in order to delay vascular complications.More »

Situation: A 36–year–old truck driver had severe allergic rhinitis and came for treatment.
Reaction: Oh my God, why was he not prescribed azelastine nasal spray?Lasson: Make sure to avoid oral antihistamines in persons who perform tasks like driving as they may cause sedation and drowsiness; instead prescribe azelastine nasal spray which is effective and non–sedating.More »

Situation: A–28–year old male presents with increased frequency and occasional blood in urine. Exami
Reaction: Oh my God! Why didn’t you check for TB?Lesson: Make Sure to rule out TB in patients with frequency, dysuria, hematuria. Sterile pyuria is the first clue to diagnosis.More »

Situation: A patient with pyogenic meningitis developed complications.
Reaction: Oh My God! Why were antibiotics not given when the meningitis was suspected?Lesson: Make sure that first dose of antibiotics is given at the time meningitis is suspected.More »

Situation: A rape victim developed HIV infection.
Reaction: Oh my God! Why was she not given post exposure ART prophylaxis? Lesson: Make sure all rape victims are counseled for HIV post exposure ART prophylaxis.More »

Situation: A patient with rheumatoid arthritis developed deformity.
Reaction: Oh my God! why was treatment not started early?Lesson: Make sure all patients are started with specific treatments within 3 months of diagnosis of rheumatoid arthritis.More »

Situation: A diabetic hypertensive was denied a beta–blocker because of traditional teaching.
Reaction: Oh my God! You should have used nebivolol.Lesson: Make sure that diabetics are not denied beta–blockers when indicated. Nebivolol has no effect on glucose metabolism unlike atenolol. (Source: Am J Hypertens 2005;18 (12, pt. 2):169S–176S)More »

Situation: A patient with pyogenic meningitis developed complications.
Reaction: Oh my God! Why was an antibiotic not given when meningitis was suspected?Lesson: Make sure that the first dose of antibiotic is given at the time when meningitis is suspected.More »