Rubor, Dolor, Calor, Tumor
Blog Address: http://blogs.medscape.com/rdct
November 12, 2012

Can is not Ought

My goal of late would appear to be to try and alienate as many of my readers as I possible can.  It isn't. Really.  But one of principles by which I try and live is to be straight forward, within the boundaries of propriety.   I have gathered a bunch of teaching awards from the residents over the years but the one for which I am most proud was being voted "Attending most likely to tell it like it is."

So with that as background,  I will confess to a serious lack of fondness for dog owners.  Partly it's my neighbors, who think I want to listen to their dogs bark and howl despite have been given information to the contrary.  And I am never happy that dogs use my yard as a toilet.  And I hate it when some dog comes running up barking at me or...

Posted By: Mark Crislip  

November 8, 2012

What infects humans, crocodiles and dolphins?

I get called for a necrotizing fasciitis of the perineum aka Fourniers.  Icky disease, since the treatment of necrotizing fasciitis is mostly surgical and no one wants to have their perineum debrided.

Fourniers is usually seen in diabetics (as here, poorly controlled and a smoker as well) and is usually a mixed infection (streptococci and anaerobes and the odd Enterobacteriace...

Posted By: Mark Crislip  

November 6, 2012

Its been a long time

Thank goodness for prosthetic joints.  With large parts of my practice slowly evaporating thanks to bundles, SKIP and aggressive infection control, I can always count on the occasional prosthetic joint to get infected.

The patient had a prosthetic joint placed 7 months ago and for the first 6 months had no issues.  Then he had increasing pain for a week or three before ad...

Posted By: Mark Crislip  

November 3, 2012

Confirmation Bias

Almost every patient I see has an infection, and if not an infection then some sort of inflammatory state.  So there is ample opportunity for me to confirm the bee lodged firmly in my bonnet (there's a mental picture for you) that infections of all kinds lead to vascular events.

The sequence is simple. &...

Posted By: Mark Crislip  

October 30, 2012

Playing the Odds

I get a call about a patient with urosepsis.  Blood and urine cultures with E. fergusonii.  Patient has a prosthetic valve and they assume the patient needs to be treated for endocarditis, right?

Got me.  So I went and saw the patient.  Classic UTI symptoms with rapid progression to sepsis and equally rapid resolution of the symptoms.No stigmata what so ever...

Posted By: Mark Crislip  

October 28, 2012

100%

Watch the video AFTER reading the post.  I want it at the bottom, but the blog puts it at the top. We are but pawns to the computer.

We have been at 100% for hand hygiene compliance for the last couple of months.  Really. 100%.  You do not believe me?  Let me tell you about it.

A while back I decided that our hand hygiene compliance program was flawed.  ...

Posted By: Mark Crislip  

October 26, 2012

I have seen the only two cases. Ever.

The patient is obese, diabetic and admitted to the hospital with acute rubor, dolor, calor and tumor of the leg.  He is a touch septic and requires a bit of Levophed to maintain his blood pressure.  

His leg is red and swollen, but areas are more cool than hot, always a concern for vascular insufficiency instead of infection.  Because he had been in the hospital a mo...

Posted By: Mark Crislip  

October 24, 2012

Dirty Laundry

I have been involved with infection control for 6 hospitals for my entire career.  Because of infection control and its links to quality I know things. I know peoples dirty medical laundry.  Part of infection control/quality is identifying issues and correcting them and over the years we have washed a lot of laundry, metaphorically speaking, with excellent results.  Every ye...

Posted By: Mark Crislip  

October 22, 2012

Aesthetic

Everyone has an aesthetic. I like simple, uncluttered, clean lines, black and white. Like my website. Not that you would know it to look at any other space for which I am responsible. Or my brain. That's a mess.

One of the hospitals I go to has to have one of the ugliest interior designs ever for a hospital. Of any building for that matter. And remember, I live in the city that has the ...

Posted By: Mark Crislip  

October 19, 2012

An Onion on my Belt

It is remarkable how rapidly bacteria can lead to morbidity.  My old partner, since retired, used to observe that the patients that did the worst with staph infections were those who least likely to get a staph infection.  Normal people would get S. aureus and go to stink, while the IVDA, the diabetic, the dialysis patient, with their constant exposure to S. aureus, ...

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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