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Case Conference - Dr. Reyner

1/8/2015

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Tetanus

Picture
• Tetanus is caused by anaerobic spore forming GPR and is transmitted via contaminated wounds and tissue injury.
• Consider the diagnosis in patients presenting with trismus, which is the cardinal feature. 
• There are very few disorders of generalized stiffness in patients with preserved consciousness: stiff personsyndrome, tetanus, drug induced dystonia, hysteria, and strychnine poisoning (rat poison)
• 
Verify tetanus immunization history in all trauma patients and IV drug users.

Leishmeniasis

• Leishmeniasis is a vector born disease transmitted by the sandfly.
• 2nd largest parasitic killer in the world!
• Incubation period: weeks to months
• Classic presentation:  Pink-colored papule -> enlarges into a nodule or plaque-like lesion (often with central softening) -> painless ulceration with an indurated 
border

Guillan Barre Syndrome

• Guillan Barre Syndrome is the most common acute paralytic disease in the west.
• Diagnosis requires clinical suspicion, LP, and EMG studies.
• LP classically shows albumino-cytologic dissociation (elevated protein); however, normal protein level does NOT rule-out the condition.
• Patients in the early stage of their illness may not have reflex changes.
• Criteria for intubation:  1 major or  2 minor criteria:
– MAJOR: Hypercarbia, arterial CO2 > 48 mm Hg, Hypoxemia, paO2 < 56 mmg Hg, FVC < 15 cc/kg or NIF < -25 cm H20
– MINOR: Inefficient 
cough, Impaired swallowing, and Atelectasis
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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