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May 10, 2010

Out, damned spot! out, I say!

I am, not unsurprizingly, a big proponent of hand washing and hand hygiene.  While we have only been aware of the importance of hand hygiene for 160 years, the last 10 years have seen a renewed interest in clean hands. For years the issue preventing compliance with the adherence, or is it adherence with the compliance,  was time.  To wash hands appropriately at each and every opportunity would mean that some providers would spend most of their work day scrubbing their hands rather than providing patient care.

The big change was alcohol foam.  Five seconds using the foam is better than 30 seconds at the sink, and certainly more practical.  It took me a while to become accustomed to the appropriate use of the foam.  I thought it was to be used li...

Posted By: Mark Crislip  

May 8, 2010

Measles. What is old is new again.

There was a recent measles outbreak in British Columbia, couple of hundred miles to the north.  I assume that, like its failure with Cryptococcus gattii, the border patrol fail to prevent this organism from crossing the border and I will soon see cases of measles in Portland.  I have always wanted to see a real live Koplik spot.  

I had assumed I would never see ...

Posted By: Mark Crislip  

May 6, 2010

Picky Picky

To state the obvious, infections can make people real sick, real fast.

The patient is a young male with chronic medical problems that require prednisone and a lack of insurance that precludes appropriate follow up.  He has the onset of a severe frontal headache, fevers, and decreased mental status.

Ominous.

He comes to the ER, or rather is brought in, and he ha...

Posted By: Mark Crislip  

May 4, 2010

Batting 126

The patient is a middle aged male who is admitted with community acquired pneumonia.  Nothing special at first, he is placed on ceftriaxone and azithromycin, but over the first 24 hours things do not go well.

He has progressive and rapid progression of his infiltrates, goes into respiratory failure and ends up on a vent, in the ICU and now on zosin and vancomycin.  He con...

Posted By: Mark Crislip  

May 2, 2010

Miliary

Certain words will lead to quick associations.  ID is all about disease associations. 

If you say Central Valley to an ID doc, he will say coccidiomycosis.

If you say Cat, she will say Pasteurella, although I am more likely to say Power. The Greatest. 

If you say potato, they will say botulism, not po-tah-toe. At least so I would hope.

And if ...

Posted By: Mark Crislip  

April 30, 2010

Rip, Tear, and Fever

I am currently an old arrogant sob.  It is part of my charm, nest pas? So I have a patient with a fever. I do the usual fever work up and find nothing. She has a few afebrile days, then spikes another temperature, gets tachycardic and tachypneic and is transferred back to the hospital where they work her up and find no cause of her fever. Or do they?

She had initially been at ...

Posted By: Mark Crislip  

April 29, 2010

Any Bug, Any Place

That’s the thing about infectious diseases.  Any bug can show up in any site at any time. Many a CV has grown as a result.  Sure, some bugs are more common than others, and if you play the odds most of the time you will be right.  But not always, which is why you get cultures.

The patient is an elderyish male who has had an artificial hip for years.  For t...

Posted By: Mark Crislip  

April 26, 2010

Insect Poo, Insect Puke

The patient is elderly, demented, diabetic and evidently just wants to be left alone.   Chronic stasis and lack of wound care can be a bad combination, and at some point, we are not sure when, his hyperkeratotic leg broke down and became infected. And necrotic.  And then the flies came.

When the ambulance drivers finally opened the door it was noted that the room smelled ...

Posted By: Mark Crislip  

April 24, 2010

When to operate

One interpretation of quantum mechanics is the many worlds theory, which to quote the ever helpful wikipedia, "In layman's terms, there is a very large—perhaps infinite—number of universes, and everything that could possibly have happened in our past, but didn't, has occurred in the past of some other universe or universes."

Quantum mechanics makes my brain hurt.  ...

Posted By: Mark Crislip  

April 22, 2010

The Real Monas

The patient is a middle aged female who comes in with chemotherapy induced neutropenia and fevers. Not that uncommon.  But, unlike most patients, she has focal symptoms.  She has a collection of a half dozen tender, purple-red pustules with surrounding ecthyma.

Her WBC is normal the next day, and the fevers are gone, and cultures of one of the lesions grows Pseudomonas ae...

Posted By: Mark Crislip  

 
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About This Blog

For the Benefit of Mr Kite, there will be ID tonight. Infectious Diseases! Antibiotics! Viruses and Bacteria and Fungi! Oh my! Exclamation marks!!!!!! No trampolines, nor will any band be playing at 10 to 6. And Henry the Horse died of the Strangles. Sorry. That's the problem with infections.

The endless excitement that is the daily practice of Infectious Diseases in a Portland teaching hospital! The need for meta data!

Every day I make infectious disease rounds in the hospital and see at least one cool case or learn something new. 25 years and I still do not know everything. Why be selfish and keep all of that wonder and knowledge to myself? This blog will be a mostly qod account of days events, a cool ID case, a referenced pearl, and a minimum of 1 horrible, yet ultimately feeble, attempt at humor.

While usually written in the present tense, the cases are not necessarily current and all identifying information is altered or obscured as long as it is not absolutely pertinent to the case. Can't have a female with prostate infection for example.

I write these at night or in spare moments. There is always someone who will quibble about spelling, punctuation or grammar. My response is live with it. It's a blog, not Mandel.

Read and listen to more of me at my multimedia empire linked below.

The first 2 years blog posts have been collected and edited and are available on Amazon as The Puswhisperer, Volumes 1 and 2. Really. Perfect for the pus lover in your life.
Because The World Needs More Mark Crislip (tm).

Disclosure: Mark A. Crislip, MD, has disclosed the following relevant financial relationships:
Received income in an amount equal to or greater than $250 from: Pusware LLC
Have a 5% or greater equity interest in: Pusware LLC (owner)

  • Mark Crislip

    Mark Crislip, MD, has been practicing in infectious diseases in Portland, Oregon, since 1990. He is nobody from nowhere, but he has an enormous ego that leads him to think someone might care about what he has to say about infectious diseases. And so he blogs and podcasts and writes on the most endlessly fascinating specialty in all of medicine.

    Mark A. Crislip, MD, has disclosed the following relevant financial relationships: Owner, Pusware LLC. He as not talked to a drug rep in over 25 years and does not even eat the pizza provided at conferences. But he is for sale for the right price. Please. Someone. Buy me.

The content of this blog does not necessarily reflect the viewpoints of Medscape.
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