A 34 year-old female comes to the emergency room with fever, chills, productive cough and dizziness. She is a known intravenous drug user with multiple visits to the emergency room in previous months. Her echocardiogram shows multiple vegetations over the tricuspid valve. One medical student who examined her told you that she felt Osler nodes in the physical examination of this patient. Of the following, which is the correct description of the Osler nodes?
Which is the most commonly affected heart valve in endocarditis in patients who are injection drug users?
A 24 year-old male comes to the emergency room with fever, chills, weakness, chest pain with deep inspiration, persistent, productive cough with greenish sputum mixed with blood, and shortness of breath. On examination, his temperature is 103.5 °F, heart rate is 122 beats per minute (bpm), blood pressure is 100/71 mm Hg, and respiratory rate is 26 breaths per minute. He is alert and awake. Oral examination shows black staining on the teeth. Fundoscopic examination shows round, flame-shaped hemorrhages with a pale center in the posterior pole of the retina. Auscultation of lungs reveals inspiratory rales bilaterally. Cardiac examination shows tachycardia with a regular rhythm with a high pitched holosystolic murmur loudest in the fourth intercostal space at the left lower sternal border. There are splinter hemorrhages under the nails in both hands. He has bilateral axillary lymphadenopathy, hyperpigmentation and scarring over both forearms. When you ask him in a non-judgmental way, the patient reveals that he is a regular intravenous drug user. His laboratory tests are remarkable for leukocytosis, anemia, hematuria, elevated erythrocyte sedimentation rate, elevated C-reactive protein level, and elevated rheumatoid factor. Blood cultures were drawn and sent to the lab. Of the following, which is the next best step in the management of this patient?
A 24 year-old male is brought to the emergency room in shock. As you evaluate his condition, you wanted to check his central venous pressure. In the central venous pressure (CVP) waveform, the ‘c’ wave represents which of the following?
