Pneumococcal Meningitis with HUS
Usually serotypes outside of 13-valent vaccine
If you suspect, initial treatment with: - Cefotaxime 300 mg/kg/day IV (max 12g/day) in 3 doses OR
- Ceftriaxone 100mg/kg/day IV (max 4g/day) in 2 doses PLUS
- Vancomycin 60mg/kg/day IV (max 4g/day) in 4 doses
Recognize classic triad:
- Microangiopathic hemolytic anemia
- Acute Kidney Injury
- PNA - 70%
- Meningitis - 20-30%
- Others - Otitis, sinusitis, bacteremia
- Not like STEC-HUS
- Needs Tx with Abx
- Pneumococcal leads to higher M&M
Hemoptysis from 5-yr old retained GSW
Delayed Pulmonary Hemorrhage from FB
- Up to 30 yrs latency reported
- Present with intermittent hemoptysis
- Pulm Art or Aortic Pseudoaneurysm
- AVMs with R -> L shunts
- Embolization - arterial or venous
No universal definition - "Is this life threatening?"
Initial ED Management
- ID bleeding lung and position dependently
- A - Establish airway (8-0 ETT or bigger for bronchoscope)
- B - Ensure good gas exchange on vent
- C - Stop bleeding! Restore volume, give PRBCs, reverse coagulopathy,etc...
Regular Wide Complex Tachycardia
- Consider VT until proven otherwise!!!
- 80% is VT by numbers
- Algorithms to differentiate SVT are difficult to remember
- If you treat for VT, won't harm SVT
- Nodal blockers for SVT can send VT into VF -- PLACE PADS with Adenosine!
A great analysis of EP and Cardiologist failure in applying Brugada to electrophysiologically proven VT.
Two fantastic talks from the ever-salient @amalmattu
- VT vs SVT with Aberrancy
- Adenosine Sensitive VT