CMC COMPENDIUM
  • 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

Anaphylaxis - Dr. Jackson

3/12/2015

0 Comments

 
Picture
- Early recognition and treatment is critical.... give epinephrine EARLY and OFTEN
- Treat anaphylaxis as a spectrum... as short as 2 hour observation up to admission
- Steroid duration depends on who you ask. No good evidence to support or refute their use.
- Vasopression for anaphylatic shock with suboptimal epi response.

- Consider glucagon for those patients on beta-blockers.

0 Comments

Disaster Medicine Extravaganza - Dr. Noste

12/12/2013

0 Comments

 
Picture
Definitions
  • Disaster = "A serious disruption of the functioning of society, causing wideshpread human, material, or enviornmental losses which exceed the ability of affected society to cope using only its own resources" (UN, 1992). Emphasis is the inability of a society (community, state, nation) to respond to the event.
  • Disaster cycle is composed of:
  1. Preparation
  2. Event Response
  3. Recovery
  4. Mitigation
  • Resilience = The capacity to cope with or recover from emergencies and disasters  
Basics of Personal Security for Travel to Developing Countries - Macpherson

  • Before you travel, do some research (can consult the following sites)
- http://www.travel.state.gov
- https://www.cia.gov/library/publications/the-world-factbook/
- http://www.doingbusiness.org/
- http://www.lonelyplanet.com

  • The most important aspect of security when you travel is your situational awareness
  1. Pay attention to your surroundings
  2. Be sensitive to change
  3. Act accordingly (trust your instincts)

  • Travel to/from and within the country
  1. Cell phone  - most vital piece of equipment (consider getting a local cell phone)
  2. Don't travel with more than you are willing to lose
  3. Don't travel with more than you can carry yourself
  4. Have an advance plan for travel from airport to hotel
  5. Don't travel around alone
  6. Find out what areas to avoid
  7. Vary your route
  • Be careful what you post on social media  

Pediatric Disaster Medicine and Triage - Noste
  • The pediatric population is at higher risk of injury during a MCI/disaster/CBRNE event
  1. Body heat loss is increased during exposure or following decon
  2. Vital sign screening is frequently inadequate
  3. Internal organ damage is often overlooked
  4. Thinner skin is more vulnerable to the effects of radiation
  5. Typically closer to the ground and more likely to ingest heavier than air gases or contaminated particulate matter
  •  Children <4 years old have a 4.5x rate of death from cholera  
  • JumpSTART modifications for pediatric MCI
  1. Why? Cap refill is unreliable and strongly influenced by the environment in the pediatric patient
  2. Respirations may be normally > 30/min
  3. Not all children can walk or follow commands
  4. Biggest modifications are: Normal respiration rate 15-45 bpm, if patient is apneic after repositioning the airway give 5 rescue breaths (if no response then triage code black, if response then triage code red),
  5. There is a high rate of "over-triage" pediatric patients in MCI (300-400%)

0 Comments

Myths About Electricity - Dr. Troha

9/15/2013

0 Comments

 
Myth 1 - electrical injury isn't common.  Simply put: it is.

Myth 2 - Voltage is the most important determinant of the injury.  Nope : it is Current... but it is often only the Voltage that we know in the ED.

Myth 3 - High voltage (1,000 or greater) is more likely to kill than low voltage.  Again, voltage is not the determinant.  Amperage is power.
Picture
Myth 4 - The extent of surface burn determines the extent of the injury. Unfortunately, skin findings can be misleading.

Myth 5 - The pathway the electricity takes through the body predicts the pattern of injury.  It is helpful to be able to see evidence of the path that the electricity took (ex, from toe to hand), but once again, this can be misleading.

Myth 6 - All patients with electric injuries require 24 hours of cardiac monitoring.  Most patients who arrive to the ED without having had an arrhythmia and who have a normal ECG with no symptoms do not require prolonged monitoring.

Myth 7 - Cardiac monitoring and further testing is always required for TASER injuries. There have been deaths noted with TASER injuries, but these have all been associated with patients who had "excited delirium" -- PCP and TASER is a bad combination.

Myth 8 - Victims of lightning injury should not undergo prolonged resuscitation.  Lightning victims can have meaningful recoveries after prolonged resuscitation.  They can even present with Fixed and Dilated pupils.  Do not tell EMS providers to pronounce the victim in the field. Continue to resuscitate and bring them to the ED to further assess.

0 Comments

High Altitude Illnesses - Dr. Wedmore

9/15/2013

0 Comments

 
Acute Mountain Sickness (AMS)
  • HISTORICAL diagnosis  - feels like a bad hangover
  • Altitude + headache + (dizziness or nausea/vomiting or insomnia or anorexia)
  • Previous history of AMS most important predictor, followed by total height and speed of ascent.
  • Tx - ASA, APAP, Acetazolamide 250mg PO BID treatment, Descent.
  • Prophylaxis
  1. Acetazolamide 125mg PO BID 24hrs PTA x 72 hours,
  2. Ibuprofen
  3. Ginkgo Biloba 120mg PO BID (for your hippie/granola friends)
  4. Dexamethasone 4mg PO q8h
Picture
High Altitude Cerebral Edema (HACE)
  • # 1 cause of death at altitude
  • AMS + progressive neuro findings/ataxia
  • Tx - Descent, O2, Dexamethasone 8mg x1, then 4mg q6h

High Altitude Pulmonary Edema (HAPE)
  • Different pathophys than Cardiac pulm edema
  • Normal PCWP - not a fluid overload problem, rather a fluid distribution problem, NO lasix!!
  • Hypoxia causes vasoconstriction causing leaking capillaries which worsens hypoxia and vasoconstriction
  • HAPE death spiral negative feedback loop. Takes 2-4 days
  • Cough, dyspnea, fatigue, leukocytosis common
  • 50% overlap of HACE and HAPE
  • Tx - Descent resolves symptoms quickly (min 1000m), 02, nifedipine
  • Prophylaxis - Nifedipine 30-60mg QD, Salmeterol 125mg inh q12h, dexamethasone, diamox if mild,  viagra/cialis

0 Comments

Pain Control in Austere Environment - Dr. Wedmore

9/15/2013

0 Comments

 
Pain Control is Important -
where ever you go!!
  • But when you are in difficult environments with sparse resources, what you bring is important!
  • The therapy needs to be:
  1. Lightweight
  2. Stable when not refrigerated.
  3. EFFICACIOUS!
  4. Have low side-effect profile (you really don't want to make things worse).
Picture
Some Pain Control Options
  • Non-Pharm
  1. Placebo Effect and Empathy are POWERFUL!! You have a powerful Placebo Effect... use this power!!
  2. RICE does work.
  3. Delayed heat (100-104 degree) - Decreases GABA fiber.
  4. Acupuncture - Actually has been proven to help with pain (acupuncture needles are easy to pack)
  5. Plants/herbs - BE CAREFUL!  Be 100% certain you know what you are dealing with.
  • Pharm
  1. APAP and Ibuprofen - Can be taken together for synergestic effect.
  2. Military uses Meloxicam - 90% Cox2 so no platelet inhibition for young healthy (low risk of renal failure).
  3. Fentanyl intranasal or lollipop - 800 micrograms lozenge taped to finger in case of falling asleep
  4. Ketamine - 1/10th dissociative dose (0.1 mg/kg), not a controlled drug, minimal side effects at low dose, opioid sparing effect.  Don't give if hx of schizophrenia. 
  5. Local anesthetics and regional blocks - If you only have room for one, grab Bupivacaine.


WE can use ketamine here for pain control...talk to the nurses before you order it though... it might be misunderstood.
0 Comments

Envemonations

7/17/2013

0 Comments

 
Crotalid Envenomations Dr. Beuhler

  • 2 classes of poisonous snake in NC - pit vipers & coral snakes.  Pit vipers make up the majority of bites we're going to see (Eastern diamondback, Timber rattler, Pygmy rattlesnake, cotton mouth & copperhead)
  • The venom in the pit vipers is made to digest tissues - has proteolytic and hyaluronisdase activity - this leads to localized extremity dysfunction & systemic effects (emesis, tachycardia, hypotension, flushing, mytoxicity, renal toxicity, allergic reactions, angioedema, coagulopathy, and renal dysfunction)
  • Pit viper venom has a degree of neurotoxin activity as well which can lead to weakness, ptosis, and fasiculations as well as localized numbness at bite site

Important steps in management of bite care:

  1. First aid: NO ICE; NO TOURNIQUET; Elevation of affected site - don't bend major joints 90 degrees - need to make sure there is good lymphatic flow 
  2. Grade bite - this will help determine administration of Crofab, length of observation vs admission 
  • Mild - mild swelling, no systemic involvement or lab abnormalities
  • Moderate - <50% limb involvement, minimal systemic involvement
  • Severe - >50% of limb involvement (crosses major joint), lab abnormalities, systemic effects
3. Decision to treat with Crofab is multifactorial - should be used only in high risk populations or those with moderate to severe envenomations. 

Don't just treat lab abnormalities
   

a. Crofab = 10cc/hr; 4 vials & reevaluate after 1-2 hrs. 
Remember crofab interrupts coagulopathy & helps lower compartment pressures & possibly helps with pain - it will NOT stop or reverse local tissue destruction

If you DC home have follow up in < 24 hrs for wound reevaluation  
 
0 Comments

    Archives

    August 2018
    February 2018
    January 2018
    December 2017
    October 2017
    September 2017
    August 2017
    July 2017
    June 2017
    May 2017
    April 2017
    March 2017
    February 2017
    January 2017
    December 2016
    November 2016
    October 2016
    September 2016
    August 2016
    July 2016
    June 2016
    May 2016
    April 2016
    March 2016
    February 2016
    January 2016
    December 2015
    November 2015
    October 2015
    September 2015
    August 2015
    July 2015
    June 2015
    May 2015
    April 2015
    March 2015
    February 2015
    January 2015
    December 2014
    November 2014
    October 2014
    September 2014
    August 2014
    July 2014
    June 2014
    May 2014
    April 2014
    March 2014
    February 2014
    January 2014
    December 2013
    November 2013
    October 2013
    September 2013
    August 2013
    July 2013

    Categories

    All
    Abdominal Pain
    Abdominal-pain
    Airway
    Back Pain
    Back Pain
    Bleeding
    Change-in-mental-status
    Chest Pain
    Dizziness
    Ecg
    Emboli
    Environmental
    Fever
    Gyn
    Headache
    Hypertension
    Infectious Disease
    Pain
    Pediatric Emergency
    Professionalism
    Psych
    Respiratory Distress
    Sepsis
    Shock
    Toxins
    Trauma
    Vomiting
    Weakness

    RSS Feed

    Tweets by @PedEMMorsels
Powered by Create your own unique website with customizable templates.
  • 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