Lava Lamp-Induced Methemoglobinemia in Dementia: A Case Report.

An elderly patient with progressive dementia presented with nonspecific symptoms of fatigue, skin discoloration, shortness of breath, and altered mental status. She quickly developed respiratory failure requiring emergent endotracheal intubation. Initial laboratory results revealed methemoglobinemia levels greater than 30% with blood appearing black in hue. The etiology of her acute symptoms and the inciting substance of the disease was an ongoing discussion with the patient's family, which ultimately revealed accidental ingestion of lava lamp fluid as the cause. Although rare, methemoglobinemia is a medical emergency requiring prompt diagnosis and treatment. When a thorough history fails to reveal a possible source, alternative origins should be investigated, such as household products.

Ohio Response to COVID-19 and Its Impact on Interventional Pain Management Practices.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has drastically altered daily living and medical care for Ohio residents and the practice of medicine for the interventional pain management physician. As a state, Ohio tends to be demographically representative of the broader US population. OBJECTIVE: Reviewing the efforts deployed by Ohio to flatten the COVID-19 infection curve and reduce the spread of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an important component of determining optimal procedures for mitigating the effects of the COVID-19 pandemic. METHODS: Over the course of several announcements and orders during the months of March and April, new policies were put into place to prevent COVID-19 transmission, which included efforts to facilitate social distancing and ensure the health care system could manage the number of COVID-19 cases at peak infection rate. Efforts directed toward medical providers included delay of elective procedures, expansion of telehealth options, and new temporary guidance for prescribing controlled substances. RESULTS: The Ohio COVID-19 containment approach resulted in a substantial reduction in COVID-19 cases compared with early models of disease spread, and the state has begun a phased reopening. Continued vigilance in applying social distancing and infection control measures will be a critical component of preventing or reducing the impact of a second wave of COVID-19 in Ohio. LIMITATIONS: A narrative review with paucity of literature.

Medical management in the acute hip fracture patient: a comprehensive review for the internist.

Each year, more than 250,000 Americans will suffer a broken hip from a fall from no more than standing height. The National Osteoporosis Foundation estimates that more than 500,000 acute hip fractures will occur annually by the year 2040. The costs associated with this healthcare phenomenon are staggering and will continue to increase with an aging population.Hospitalists routinely comanage orthopedic patients as either consultants or as primary physicians in the hospital setting. A unique set of problems exists in this population. Among them are perioperative cardiac risk, perioperative anemia from acute blood loss, venous thromboembolism prophylaxis, and problems with the timing of surgery. It is imperative that hospitalists understand the orthopedic surgeon's point of view in managing these particular problems and become familiar with the evidence supporting or refuting treatment modalities related to these subject areas. In addition, an understanding of the anatomy and surgical options and complications related to each type of fracture allows the hospitalist to become familiar with postoperative rehabilitation needs. It cannot be overstated that addressing hip fracture prevention must be a part of every patient's perioperative care because the incidence of a repeat fracture is significant. Morbidity related to the fracture and comorbidities also need close examination.This article aims to provide a solid understanding of the issues associated with the acute hip fracture population to enhance practice and allow for the best outcome for patients.

The heart of the matter.

A 65-year-old Hispanic man receiving peritoneal dialysis presented to the emergency department complaining of the sudden onset of numbness and tingling of the right side of his body and face with associated nausea, vomiting, vertigo, and blurry vision. Further testing revealed a large, mobile mass on his mitral valve, leading to a diagnosis of endocarditis with embolic phenomena. The presentation, diagnosis, and treatment of endocarditis are discussed here.