The sooner the better

Article Abstract:

A 19-year-old woman with purpura fulminans may have had a better outcome if she had sought treatment earlier. Purpura fulminans is a severe and rapidly fatal hemorrhagic disease that usually follows an infectious illness. She was admitted to the hospital with a fever, muscle and joint pain and a rash over her entire body. She had developed symptoms during a vacation in Mexico. She had been so weak that she had to board the plane in a wheelchair. Despite the development of symptoms, she had not tried to get any type of medical care in Mexico. She was treated in the hospital with antibiotics for meningococcemia, or the presence of the bacterium Neisseria meningitidis in the circulating blood. Treatment with heparin and and fresh-frozen plasma was begun after a diagnosis of purpura fulminans. She developed several serious complications during an extended hospitalization. Both her legs were amputated below the knee after she developed gangrene.

Diseases, Meningococcal infections, Travelers, Thrombocytopenic purpura

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The red baron

Article Abstract:

A 33-year-old man was diagnosed with Munchausen's syndrome. Munchausen's syndrome is characterized by fabrication of symptoms to get medical attention. The patient had been coughing up blood and passing blood in his urine for two days prior to hospital admission. He reported a two-year history of Goodpasture's syndrome, a kidney disorder. He had been treated with drugs since his diagnosis, and reported one relapse approximately six months before admission. He continued to spit up blood and had blood in his urine in the hospital, despite treatment with corticosteroid drugs and plasma exchange. He was treated with narcotics for severe side pain. Doctors become suspicious when he was able to talk during reported episodes of severe pain. He began changing his medical history, and did not comply with nurses' orders. He was referred for psychiatric treatment after diagnosis of Munchausen's syndrome.

Somatoform disorders, Factitious disorder, Factitious disorders

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Insertion of femoral-vein catheters for practice by medical house officers during cardiopulmonary resuscitation

Article Abstract:

It is unethical for residents to practice catheterization on patients who are receiving CPR. In a survey of 234 medical residents, 34% believed it was appropriate to practice catheterization on a patient receiving CPR. Sixteen percent had done this themselves. Some believed the patient was already dead or that future patients would benefit from their practice. However, the patient by definition did not consent to this procedure and would not benefit from it. This violates informed consent and the principle of giving patients treatments that will benefit them.

Training, Study and teaching, Residents (Medicine), Catheterization

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