Dog bites can have very serious repercussions in a child’s life and can change their behavior, functioning, personality, self-esteem, impact a child’s educational progress as well as anxiety and years of counseling. For example, this patient is a seven-year-old white female, experienced a severe dog bite on her face. This was the result of a neighbor not keeping his Pit Bull on a leash. The neighbor was subsequently arrested and charged with Child Endangerment. The patient is now left with some significant scarring on her face. She is teased about this at school and her self-esteem has become quite low. Prior to the dog bite, she was a normal little girl and did well in all aspects of her life. Since the dog bite, she has had a deterioration in functioning.
Breast surgery that utilizes breast implants is very common and includes surgery for both cosmetic and reconstructive diagnoses. As in all procedures, informed consent is a very important component in preparing the patient for surgery. Lack of sufficient informed consent before a procedure that uses breast implants can reach the level of malpractice.
A patient consulted with her Plastic Surgeon about having a breast augmentation. As a 4’ 11” person who weighed 96 lbs., she told the doctor that she currently wore a 32 a bra and wanted to be augmented so she could wear a 36 D bra. She was very concerned about the possibility of implant rupture; she did not want to face the extra expense this would cost her. Her doctor assured her that he could surgically place implants that would give her the size she wanted and told her that, although he had never seen a patient with ruptured implants, if the implants did rupture, her insurance company would cover those costs. She had the surgery performed but was very unhappy because her bra size was only 34B, much smaller than her desired size. Also, 5 years later one of the implants ruptured, requiring removal and replacement. Her insurance company did not cover the costs of that surgery and she had to pay for this surgery out of pocket.
Dialysis Unit Communication: At present, there are more than 6500 dialysis centers in the United States that provide life-saving care for patients with end-stage renal disease (ESRD) requiring renal replacement therapy. This often thrice-weekly form of treatment has become commonplace in virtually every major city and suburb in the US. Dialysis care is almost universally provided by Nephrologists (physicians specializing in the diagnosis and treatment of kidney diseases) in close collaboration with a team of health care providers that includes specially trained dialysis nurses technicians, social workers, and dieticians. Dialysis care is now considered sufficiently routine that the Nephrologists need not be present during each treatment.
Potential Consequences of Dialysis: As with any procedure, hemodialysis carrels a small but significant risk of complication including infection, low blood pressure, and bleeding. The risk of choric blood loss is real, even under ideal conditions; however, blood loss may also be acute, especially in patients with plastic dialysis catheters that are susceptible to accidental disconnection during or after the dialysis procedure.
Hyponatremia is defined as a lower than normal serum sodium concentration using routine laboratory testing of serum electrolytes. Although chronic hyponatremia below 120 mEq almost universally prompts medical investigation, milder forms are usually overlooked or disregarded as being of little clinical significance. Recently, mild-moderate hyponatremia (i.e., a serum sodium concentration >125-135 mEq/L) has been associated with distinct symptoms as well as with increased mortality after hospitalization.
What causes hyponatremia? Many conditions are associated with chronic hyponatremia, the single most common electrolyte abnormality. These include inflammation in the brain or lung, cancers, thyroid disease, kidney disease, heart failure, and several categories of medications such as oral hypoglycemics (used in patients with diabetes mellitus), narcotics, diuretics, and antidepressants, particularly those agents referred to as selective serotonin receptor inhibitors (SSRI agents).
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