Methemoglobinemia

Heme in Ferric state instead of Ferrous.

O2 content: Decreased
PaO2: Normal
SaO2: Decreased (Ferric state cannot bind O2)

Left shifts O2 Dissociation curve

Causes:
---> Heme oxidized by nitro/sulfa drugs: Dapsone, Primaquine, Nitroglycerin, Quinine, Trimethoprim/Sulfamethoxazole, Nitrofurantoin.
---> Person coming from Rocky Mountains - Have high Nitro compounds in such area
---> Common in HIV - Bcoz they are Rx with Trimethoprim/Sulfamethoxazole for P.Carinii

S/S:
Cyanotic
Blood: Chocolate colored -> cause increased Deoxy-Hb

Rx:
IV Methylene Blue: Gold standard -> activates methemoglobin reductase system which is normally not operative
Ascorbic Acid: Reducing agent, ancillary therapy.

CO Poisoning

O2 content: Decreased
PaO2: Normal
SaO2: Decreased(Higher affinity of CO for Hb than O2)

Left shifts O2 dissociation curve
Inhibits Cytochrome oxidase

Causes:
Car exhaust
Space heaters
Smoke inhalation in fires(house fires-also have cyanide poisoning)
Wood stoves
Methylene Chloride

S/S:
Headache
Cherry red color of CO-Hb, masks cyanosis.
Long term: Necrosis of Globus Pallidus leading to Parkinson-like findings.

Rx:
100% O2

Normal Flora

Blood and Internal Organs
Flora:
None; Generally Sterile

Cutaneous surfaces + urethra + outer ear
Flora:
Staph. epidermidis(MC)
Staph. aureus
Corynebacteria
Streptococci
Anaerobes, e.g. Pepto-streptococci
Yeasts(Candida species)

Nose
Flora:
Staph. aureus(MC)
Staph. epidermidis

Oropharynx
Flora:
Strep. viridans including Strep mutans(MC)
Nonpathogenic Neisseria
Nontypeable H. Influenza(i.e. one with no capsule)

Gingival crevices
Flora:
Anaerobes: Bacteroids, Prevotella, Fusobacterium(MC)
Streptococcus(MC)
Actinomyces(MC)

Stomach
Flora:
None

Colon
Flora:

- In Babies, breast fed only:
Bifidobacterium(MC)
Lactobacillus
Streptococci

- In Adult:
Bacteroides/Prevotella(Predominant)
Escherichia
Bifidobacterium

Vagina
Flora:
Lactobacillus(MC)

California Letter

..... Hey guys.. Came across this blog from Harshit, where he has given near complete info on how to obtain a California Letter, also known as PTAL(Post-graduation Training Authorization Letter).. Check the link below..
California Letter

Don't tell me the procedure is too hectic guys..
U expect California Residency for nothing, Do ya??