Carolinas Emergency Medicine Residency - CMC COMPENDIUM

STDs in 2016 - Dr. Callahan

3/23/2016

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.
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.
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.
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.
Epidydimitis: Consider US also. Less than 35 or STD exposure-treat rocephin, 2 weeks doxycycline.
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.
Complications of chlamydia: infertility, PID, Reiter syndrome. Recommend treating with PO azithromycin 1 g including pregnancy.
Syphillis: treat with penicillin, different regimens depending on stage. Ocular and neurosyphilis requires CSF, admission, IV antibiotics.
Less common STDs include Chancroid, Lymphogranuloma Venereum, Donovanosis. Treat with rocephin and doxycycline.

Principles of Trauma Resuscitation - Dr. Gibbs

3/19/2016

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)

Carolinas Case COnference - Dr. West

3/3/2016

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.