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    The Symptoms:

    • This is a case report series based on real patients, built around a graphic backbone.
    • Much of the communication is visual. The graphic forms an image of the teaching points.
    • The characters are based on needs and more than one case will unfold with each episode.
    • The teaching points are folded into the graphics, the images, references, reports and the quiz.
    • The episodes allow you, as the narrative progresses, to reflect , consult the references and if you wish to form a self study project.
    • The series is intended to promote reflection and the sharing of ideas in a community linked by the forum. (you need a password for this)
    • The graphics are by Jesse Bochner, the author of the series is Michael Rosengarten

    How to use the Symptoms:

    • Follow the evolution of the cases (Enjoy Jesse Bochner's great graphics)
    • Reflect on the narrative, the differential diagnosis, the tests , and the actions you would take.
    • Visit the references and explore the online resources to reflect on and deepen your knowledge.
    • Take the quiz (you will need a password for this)
    • Reflect on your answers.
    • Share your ideas on the forum (don't be a lurker!), stimulate others to reflect, and be stimulated in turn.
    • Give us feedback and fill out the evaluation form at least once.

    Disclaimer:

    By viewing the material on this site you understand and accept that:


    · The opinions and statements expressed on this site reflect the views of the author or authors and do not necessarily reflect those of McGill.
    · The hosting of material on the McGill CME site does not signify endorsement of this material by McGill.
    · The material is solely for educational purposes for qualified health care professionals.
    · McGill University is not liable for any decision made or action taken based on the information contained in the material on this site.
    · The information cannot be used as a substitute for professional care.
    · The information does not represent a standard of care.
    · No physician-patient relationship is being established.

     

     

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    Teaching objective:

    The learner reflects on a patient who is not doing well and has a possible intestinal perforation.


    In this episode:

    • Up until the time of this admission George was working in the hospital between his chemotherapy treatments.
    • George has been rehydrated and is feeling a bit better.
    • Soon after admission he was started on Piperacillin 4.5 g IV q6h, and Metronidazole 500 mg IV q6h for a possible perforation.
    • But his lactate is elevated, and he continues to run a fever.
    • Preliminary reports from his abdominal CT suggested gas outside of the bowel.
    • Because of the possibility of a segment of ischaemic bowel, he is taken to the OR as an emergency in the middle of the night.
    • His heparin has been reversed with protamine.
    • The OR note:
      • distal ileum was thickened/edematous but very viable.
      • the anastomosis was grossly intact
      • no contamination
      • posterior aspect of anastomois is covered with omentum and mesentery of small bowel
      • no gross leak seen
    • The stool test for C-diff is pending.

     

    How to use this module:

    • Read the graphic novel strip w s
    • Take the quiz ***
    • Checkout the references
    • Join the forum***

    ***you need to have a password for this
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epi5

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Halsey J. Current and future treatment modalities for Clostridium difficile-associated disease. Am J Health Syst Pharm. 2008 Apr 15;65(8):705-15.

Libman M. Clostridium difficile:When Infection Control Poops Out... McGill CME Nov 29 2005

Planche T, Aghaizu A, Holliman R, Riley P, Poloniecki J, Breathnach A, Krishna S. Diagnosis of Clostridium difficile infection by toxin detection kits: a systematic review. Lancet Infect Dis. 2008 Dec;8(12):777-84. Epub 2008 Nov 1.

Vonberg RP, et al. Infection control measures to limit the spread of Clostridium difficile. Clin Microbiol Infect. 2008 May;14 Suppl 5:2-20.

Web sites:

U.S. National Library of Medicine: Clostridium Difficile Infections

 

More references are available on PubMed

 

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Join the forum

 

Note you have to have a password for this.

 

If you do not have one,

it is easy to get and there is no charge.

 
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