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- Early recognition and treatment is critical.... give epinephrine EARLY and OFTEN - Treat anaphylaxis as a spectrum... as short as 2 hour observation up to admission - Steroid duration depends on who you ask. No good evidence to support or refute their use. - Vasopression for anaphylatic shock with suboptimal epi response. - Consider glucagon for those patients on beta-blockers. Thrombotic Thrombocytopenic Purpura: - Can be hereditary or acquired. Acquired forms can be found as a result of a multitude of disease states. - Patients will more often present with vague symptoms including confusion/AMS rather than focal neurologic deficits attributable to a specific vascular distribution. - Treatment to consider initiating in the ED includes steroids and FFP however be wary of volume in patients with underlying cardiac disease. - VasCath can be placed in ED depending on provider comfort. - Plasma exchange has decreased mortality from 85-95% to 10-20%. Third Degree Heart Block: - Most often seen in elderly patients due to progressive fibrosis and calcification of conduction system and surrounding tissue, but can certainly be a complication of AMI. - Particularly for your elderly patients, be wary of medication side effects. - Atropine is always worth a try. Just realize more often than not it won't help you. - Hypotension? Altered mental status? Distress? PACE THE PATIENT! - Take the time to review initiation of transvenous pacing. Like the infamous ED thoracotomy or cricothyroidotomy, its a procedure we should know like the back of our hands. Final Pearl: if you're going to order an imaging study, look at the WHOLE image.
HYPOGLYCEMIA Presentation:
Not all patients recognize their own hypoglycemia well.
Some patients that are at high risk for hypoglycemia:
Treatment - we often do it wrong!
Change in Mental Status and Abnormal Laughter
Abdominal Pain in Pt who has MS and Drinks Everyday
Change in Mental Status
Pupura on Ears of Pt
Actively Seizing Patient
Patient with hx of Sz who presents after Sz
New Onset Seizure Pt
-NPH is a potentially reversible cause of dementia and early intervention can be life-changing for patients -The terms hydrocephalus and vetriculomegaly are not synonymous. All patients with NPH should have enlarged ventricles, not all elderly patients with enlarged ventricles have NPH. -Emergency department management should focus on maintaining a broad differential and managing post-shunt complications. Hypercalcemia - Hypercalcemia relatively uncommon in the ED, but highly correlated with cancer and poor prognosis - 25% of cancer patients - 50% die within a month of hypercalcemia dx - Severe levels can be life threatening - Renal failure - Dysrhythmias - Coma - Death - Occurs due to increased bone resorption and release of calcium - Bony mets release cytokines that break down bone - Tumors secrete PTHrP and an active form of Vitamin D, causing bone breakdown - Who to suspect: - Elderly - Acute confusion/MS change - Unexplained weakness - History of cancer -- especially breast, lung, lymphoma, or multiple myeloma - What to look for: - Neuropsych, GI and MSK à vague symptoms - Evaluate with serum calcium (must account for serum albumin and correct) or ionized calcium - Consider the clinical context and order additional labs/tests as necessary, including EKG and CXR Treatment Mild
Moderate
Severe
- Pamidronate – 60-90 mg over 2-24 hrs
- >18mg/dL - Renal failure - CHF |
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