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STDs in 2016 - Dr. Callahan

3/23/2016

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Picture

  1. CDC 2015 recommendations include screening all patients age 13-64 for HIV, especially if they have another STD in opt out approach. We need to consider working towards doing this here at CMC and wherever you go practice.
  2. Managing sexual partners: options include patient referral, provider referral, expedited partner therapy (EPT). EPT based on multiple RCTs appears to be superior and involves sending prescription with patient to give to partner.
  3. Sexual Assault victim: treat with rocephin, azithromycin, flagyl, hepatitis B vaccine. CDC with algorithm for HIV prophylaxis. If significant exposure and presents within 72 hours treat with zidovudine for 28 days.
  4. PID: spectrum from cervicitis to TOA and peritonitis. Strongly consider ultrasound as first line imaging. 50 % STD related. Treat uncomplicated with rocephin and 2 weeks doxycycline. TOA, pregnancy, ill appearing admit for IV antibiotics/OB GYN consultation.
  5. Epidydimitis: Consider US also. Less than 35 or STD exposure-treat rocephin, 2 weeks doxycycline.
  6. Complications of gonorrhea: PID, septic arthritis, Fitz Hugh Curtis, disseminated gonococcemia, meningitis, conjunctivitis. Neonates-day 2-5, full sepsis workup and admit for IV antibiotics.
  7. Complications of chlamydia: infertility, PID, Reiter syndrome. Recommend treating with PO azithromycin 1 g including pregnancy.
  8. Syphillis: treat with penicillin, different regimens depending on stage. Ocular and neurosyphilis requires CSF, admission, IV antibiotics.
  9. Less common STDs include Chancroid, Lymphogranuloma Venereum, Donovanosis. Treat with rocephin and doxycycline.

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Principles of Trauma Resuscitation - Dr. Gibbs

3/19/2016

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Picture
  • Prehospital hypotension is bad! Even if normal BP upon arrival.
  • Vital signs are insensitive for traumatic shock.
  • Develop a strategy for bedside testing.
  • Be cautious with interventions.
  • If you are unsure, focus on the Basics!!
  • (see the slides below)

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Carolinas Case COnference - Dr. West

3/3/2016

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Psychiatric and medical co-morbidities
  • Schizophrenia associated with 10-25 year decrease in life expectancy
  • Increased risk of medical conditions with psychiatric conditions related to compliance, access to care, and substance abuse
 
ERIC forms
  • Must be mentally ill AND dangerous to self or others
  • All patients being admitted for psychiatric reasons need an ERIC form
  • Use facts, not conclusions (eg. do not state patient is suicidal, say the patient wants to kill himself by jumping into traffic).
 
Restraints
  • Often needed, but have associated risks
  • A new oxygen requirement suggest hypoventilation, monitor for hypercapnia
  • Make sure to put the order in and complete the face to face encounter (R icon in tool bar) within one hour of initiation of restraints. 

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  • RESIDENCY
    • About CMC
    • Curriculum
    • Benefits
    • Explore Charlotte
    • Official Site
  • FELLOWSHIP
    • EMS
    • Global EM
    • Pediatric EM
    • Toxicology >
      • Tox Faculty
      • Tox Application
    • (All Others)
  • PEOPLE
    • Program Leadership
    • PGY-3
    • PGY-2
    • PGY-1
    • Alumni
  • STUDENTS/APPLICANTS
    • Medical Students at CMC
    • EM Acting Internship
    • Healthcare Disparities Externship
    • Resident Mentorship
  • #FOAMed
    • EM GuideWire
    • CMC Imaging Mastery
    • Pediatric EM Morsels
    • Blogs, etc. >
      • CMC ECG Masters
      • Core Concepts
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
  • Chiefs Corner
    • Top 20
    • Current Chiefs
    • Schedules >
      • Conference/Flashpoint
      • Block Schedule
      • ED Shift Schedule
      • AEC Moonlighting
      • Journal Club/OBP/Audits Schedule
      • Simulation
    • Resources >
      • Fox Reference Library
      • FlashPoint
      • Airway Lecture
      • Student Resources
      • PGY - 1
      • PGY - 2
      • PGY - 3
      • Simulation Reading
      • Resident Wellness
      • Resident Research
      • Resume Builder
    • Individualized Interactive Instruction