Syncope et al

Today I spent the morning in clinic, I saw quite a few interesting cases. One was the worst ear infection I have ever seen—not otitis media, or infection of the inner ear, but rather otitis externa which is infection of the ear canal. This infection had spread into the young man’s face, and one could actually see the swelling on one side of his face. Regular amoxicillin had not helped, so the doctor prescribed augmentin which is amoxicillin and a b-lactamase inhibitor which counters bacteria that are resistant to amoxicillin. Another interesting case was a man who had passed out for a few seconds while brushing his teeth yesterday—he had no signs that there was anything serious going on, so the doctor attributed it to being low on fluids combined with a vasovagal response (stimulation of the vagus nerve which slows heart rate) and sent him home. Twenty minutes later, the doctor got a call saying the man had passed out again, so the doctor had to have him come back in and get an EKG, lab work, and CT scan. I didn’t hear the results, but the doctor still thought it was most likely innocuous, and, worthless though my opinion is at the present time, I am inclined to agree. Very curious situation though. There were several other interesting cases, but I don’t have time to post all of them. As a side-note, I can say that my previously alluded to feeling of awkwardness interviewing patients my age is pretty much gone which is nice.