ASK, INFORM, and OFFER
IUD + ectopic:
May 04th, 2017
When managing patients with AG Metabolic Acidosis:
A CAT PILES MUD can help broaden your differential
A - Acetaminophen
C - CO, CN
A - AKA, Starvation ketoacidosis
T - Toluene
P - Paraldehyde, phenformin, propylene glycol
I - Isoniazid, Iron, Ibuprofen, Ischemia
L - Lactate elevation
E - Ethanol, Ethylene glycol
S - Salicylates
M - Methanol, Metformin
U - Uremia
D - DKA
Rabies - Dr. M. Zeller
Why is rabies important? Rabies has the highest case fatality rate of any infectious disease, and it is entirely preventable. Although it is rare in the United States, it is very common in the developing world and is the cause of over 20,000 deaths per year in India alone.
What is an infectious exposure? The direct exposure of saliva, CSF fluid, or CNS material to exposed wound or mucosa places an individual at risk of infection
What is not an infectious exposure? The direct exposure to urine, feces, or blood or exposure of saliva to intact skin does not place an individual at risk of infection.
How do we treat an exposure? Post exposure prophylaxis (PEP) includes a combination of local wound care, a one-time dose of human rabies immunoglobulin, and a total of four doses of rabies vaccine (on day 0, 3, 7, 14).
When do we treat an animal bite? PEP is indicated in bites caused by bats, raccoons, foxes, skunks, possums, and large rodents (beaver and woodchuck) when the animal cannot be tested within 72 hours after the exposure. PEP is also indicated in bites caused by dogs, cats, or ferrets that cannot be observed for a 10 day period by the local health department.
When do we not treat an animal bite? PEP is not indicated in bites caused by dogs, cats, or ferrets that can be observed for a 10 day period by the local health department, herbivores, or small rodents (rats, squirrels, etc.)
• Avoid diagnostic momentum from the prehospital setting and always perform your own cervical spine evaluation.
• Patients at risk for cervical spine injuries have a high-impact mechanism (diving, motorized vehicles, surfing, etc.) and/or those who present to the ED with an abnormal physical exam (altered mental status, neurologic deficits).
• The risk of delayed ICH in patients on anticoagulants is exceedingly low.
• Decision to observe or repeat head CT should be individualized per patient presentation.
• Always discuss risks of delayed ICH with patients and their families prior to discharge.