Rick A. McPheeters

Learn More
Internal medicine physicians were once known as the " physician's physician. " These clinicians were consultants or specialists to the general practitioners of society. As medicine matured, their practices changed significantly. Now internists are one of the leading primary care specialties, while remaining specialists in their own right. When the specialty(More)
A 31-year-old, who is gravida 2 para 1 at 6 weeks by last menstrual period, presents for vaginal bleeding starting approximately 5 days earlier. The bleeding was initially light, and there was no associated abdominal pain. The bleeding seemed to stop when she laid down and increased upon standing. Past medical, surgical, and social histories were(More)
We present a case report of a 10-year-old male with nephrotic syndrome who presented with a complaint of shortness of breath. The patient had been recently hospitalized for an exacerbation of nephrotic syndrome and had received steroid and diuretic therapy. Initial vital signs showed tachycardia and mild tachypnea. After being observed for more than four(More)
Establishing the etiology of tachycardia in a trauma patient is often difficult. Pediatric trauma patients present an even tougher challenge. Cardiac contusion should be suspected when other more common traumatic injuries that produce hypoxia and blood loss are excluded. The diagnosis of cardiac contusion is notoriously difficult to make largely due to the(More)
A 31-year-old male presented to the emergency department with a chief complaint of headache after being assaulted with a baseball bat to the head. He denied loss of consciousness, nausea or vomiting. Past medical and surgical history was unremarkable. On physical examination, vitals signs included elevated blood pressure (167/92 mm Hg) and tachycardia (132(More)
A three-year-old female presented to the emergency department (ED) with a chief complaint of choking for 20 minutes after ingestion of an unknown clear liquid; this was followed by one episode of emesis. On arrival she had no respiratory distress, and her symptoms had resolved. Her physical exam and vital signs were unremarkable with a room air oxygen(More)
Prediction models using multiple logistic regression are appearing with increasing frequency in the medical literature. Problems associated with these models include the complexity of computations when applied in their pure form, and lack of availability at the bedside. Personal digital assistant (PDA) hand-held devices equipped with spreadsheet software(More)
Objective: To determine whether it is the direction of the needle bevel, J-tip guidewire, or both that influences the direction of the guidewire in subclavian central line placement. Methods: A total of 1,200 trials were performed using a plastic tubular model simulating the subclavian, IJV, and SCV junction. The trials were divided into six groups: needle(More)