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Vital Signs - Use THRO2BS!

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Dear Colleagues Have you ever considered that vital signs should be presented in a clearly defined and logical format? Over my years teaching in Japan, I have experienced many hundreds of presentations. From such interactions, there appears to be no standardised way to present the vital signs. Moreover, it is commonplace for the respiratory rate, and the numerical rated pain scale to be missed off from the vital signs. Something I have found somewhat strange is the use of the term “body temperature.“ In fact, in medicine are we not always measuring the temperature of the body? Therefore, why is it important to mention the word “body“ at all? The simple fact is that we do not need to mention the word “body”; this is implied, because when the presentation is taking place it is always with respect to the patient in the first place and nothing else. In the UK, as an example, all that is mentioned is “The patient’s temperature was 37ºC.”  In order to create a more streamlined and logica...
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Giant cell arteritis - do not ignore the obvious

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  Dear Colleagues I was presented an elderly woman who had a three week history of illness which included: 1) Bitemporal headache; worse when touching the scalp. 2) Jaw claudication; she could not initially open her mouth. 3) Non-productive cough 4) Change in her voice  5) Fever of 37-38ºC 6) Weight loss of 3 kg 7) Fatigue She had been vaccinated against COVID-19 and had received a second ‘shot’ prior to the onset of symptoms.  On further questioning, the patient admitted to right neck pain and photophobia. She did not complain of stiff of the neck or skin rash. There were no other respiratory symptoms. There was no history of tuberculosis exposure or infection. Past medical and surgical history included hypertension, left lung cancer (open lobectomy only; no chemoradiation), constipation and appendicectomy as a child.  The patient was using amlodipine 5 mg once daily, senna and magnesium oxide. There were no known drug allergies.  The patient was a ‘never smoke...
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A does not always equal B

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Dear Colleagues I was recently presented an elderly man with a longstanding history of rheumatoid arthritis, who presented with an acute onset of fever followed by a cough with sputum.  History The patient experienced a fever of 38ºC with associated sweats. There were no chills or rigors.  The cough was productive of some sputum, albeit limited in quantity and frequency. There was no chest pain or dyspnea.  The patient complained of posterior neck pain, but this was not a new symptom having been present for over 1 year.  The patient lived with two other family members, but they were well. There were no new medications commenced in recent months.  The patient’s rheumatoid arthritis was poorly controlled over the last 30 years leading to severe deformity of his hands and significant disability. However, he said that his symptoms were not worse recently. He underwent total knee arthroplasties a decade ago for osteoarthritis of his knees.  The patient was using...
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Think, think, think!

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Dear Colleagues It never ceases to amaze me how some physicians are unwilling to accept a different opinion.  I was recently presented a patient in his 70s with a recent onset of fever and cough.  He was a known heavy smoker of some 50 years.  He denied contact with unwell persons, onsen/sento visits, contact with pets or previous tuberculosis exposure.  His history was remarkable for atrial fibrillation treated by ablation, congestive heart failure and chronic low back pain.  His medications included relatively standard treatments such as a beta-blocker, a loop diuretic, an aldosterone antagonist, a calcium channel anti arrhythmic agent, a direct oral anticoagulant, a non-steroidal anti-inflammatory drug, and a proton pump inhibitor.  I was informed that his physical examination was normal except for some fine lung crackles and digital clubbing.  A tentative diagnosis of an infective exacerbation of interstitial pneumonia was made and the patient was ...
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A new day

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Dear Readers I would like to welcome you all to this new medical blog where I will share anonymised information for the purposes of medical education.  I do hope you will join me here when time permits. Have a great day! JB @ Dr. Branch’s Bedside BootCamp 
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