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

Head Trauma - Dr. Gibbs

2/22/2016

0 Comments

 
Picture
Case #1 (minor TBI + discussion about clinical decision rules [CDR]) – SLIDE #30
·         GCS 15 ≠ 14 ≠ 13
·         Know what each CDR gets you
·         Pick a rule and use it (ATLS prefers Canadian, ACEP prefers New Orleans, Gibbs prefers Canadian)
·         Be cautious with the intoxicated patient (Canadian only 70% sensitive… must achieve clinical sobriety 1st)
 
Case #2 (TBI on warfarin) – SLIDE #49
·         Very high risk… be liberal with imaging
·         No CDR to identify the low-risk patient
·         Order INR on arrival 
·         Reversal of anticoagulation = resuscitation!
·          
Case #3 (severe TBI) – SLIDE #94
·         RSI with neuroprotective drugs
·         Hyperosmolar therapy with either hypertonic saline or mannitol
·         Do not hyperventilate unless there is clear clinical evidence of herniation


0 Comments

VP Shunts - Dr. Angela Johnson

2/18/2016

0 Comments

 
Picture
  • Be suspicious of shunt problems in …. Kids with shunts
  • HA, nausea, vomiting, irritability, behavior change are the weaker predictors you may miss if not vigilant
  • Malfunction common early, but eventually almost ALL get revised
  • Infection most common in first six months
  • Look at your own images!
  • Not stable – Call NSGY and consider tap


0 Comments

Cervical Artery Dissection - Dr. Asimos

10/22/2015

1 Comment

 
Picture
1. Remember to consider spontaneous cervical artery dissection in the differential diagnosis of a  headache patient.

2. The majority of patients who develop an spontaneous cervical artery dissection will not develop a stroke.

3.  Cerebral ischemia caused by cervical dissection is usually embolic rather than hemodynamic compromise caused by dissection-related stenosis or occlusion.

4.  Stroke prevention is with antiplatelet or anticoagulant therapy, with no data supporting improved outcomes with either therapy compared to the other.

5.  Endovascular therapy is increasingly being used in the acute treatment of stroke related to spontaneous cervical artery dissection.

1 Comment

Carolinas Case Conference - Dr. Beverly

10/1/2015

0 Comments

 
Picture
Cryptococcal Meningitis:
  • Opportunistic infection in HIV/AIDS patients
  • Symptoms can be vague but most commonly present with fever, neck stiffness, headache and altered mental status
  • Diagnosis is by lumbar puncture; if you are thinking about this, treat properly and treat fast
  • Mainstay of treatment is with Amphotericin B and Flucytosine

Ebstein's Anomaly:
  • Congenital malformation characterized by abnormalities of tricuspid valve and right ventricle
  • 1 in 20,000 live births; No predilection for either gender
  • Chronic hypoxemia leads to changes in blood vessel function and structure
  • These changes are likely maladaptive and may increase risk for thrombotic events


0 Comments

Neuro Imaging - Dr. Asimos

8/27/2015

0 Comments

 
Picture
The mnemonic for systematically evaluating a non-contrast head CT is “Blood Can Be Very, Very Bad”.

A  Reassuring CT:

·         No Blood is seen

·         All Cisterns are present and open

·         Brain is symmetric with normal gray-white differentiation

·         Ventricles are symmetric without dilation

·         No hyperdense Vessels are present

·         No Bone fractures


0 Comments

Benign Headaches in the ED - Dr. Goldonowicz

8/27/2015

0 Comments

 
Picture
- Only approximately 5% of all headaches that present in the ED are true emergencies
- After evaluating for potential emergencies and performing a full neuro exam, pause and consider if any of the following Red Flags are present:
  • First or worst
  • Neuro abnormalities
  • Associated symptoms
  • Persistent location/time of day
  • Unresponsive to treatment
  • Cancer, HIV, Trauma
  • Change in pattern, frequency, severity

To diagnose migraine, need 5 separate episodes of headache characterized by:
  • 4 - 72 hours in length
  • Unilateral
  • Pulsating
  • Moderate or severe
  • Aggravated by routine activity
  • With nausea/vomiting and/or photophobia/phonophobia

"Migraine” or undifferentiated benign headache, you can treat the same way in the ED

Best evidence for acute headache treatment includes the following:

  • Dark and quiet room
  • 1L Crystalloid
  • 10mg IV or PO Reglan (or Compazine)
  • 25mg IV or PO Benadryl +/-
  • 30mg IV Toradol OR 550mg PO Naproxen OR 600mg PO Ibuprofen
  • Consider 10mg IV Decadron to prevent short term headache recurrence

Avoid narcotics and barbiturates out of concern for dependency and rebound effect


0 Comments

CMC Case Conference - Dr. Allen

3/12/2015

0 Comments

 
Picture
SINUSITIS
•Intracranial complications of acute bacterial rhinosinusitis include meningitis, brain abscess, subdural empyema and cavernous sinus thrombosis. Most common presenting feature of meningitis complicating sinusitis is seizure activity.

•IDSA encourages use of antibiotics for acute bacterial sinusitis when strict diagnostic criteria are met. Amoxicillin/clavulinateremains first line therapy. 

NEONATAL VESICULAR RASH

•Many causes of vesicular rashes in the neonate are benign, but serious bacterial and viral infection must be evaluated. 

•Neonatal scabies infestation presents with vesicular rash affecting the hands, feet, wrists and face of neonates. Treatment is with a single application of permethrin 5% cream, or 5-10% sulfur suspension in petroleum.

PANCREATIC CANCER

•Pancreatic cancer presents often in late stage due to vague symptoms of weakness, abdominal pain, diarrhea and jaundice. 

•Recurrent visits for similar chronic complaints carry high risk. Consider serious pathology as underlying source.

0 Comments

M&M - Dr. Reyner

7/10/2014

0 Comments

 
Picture
Case 1 - S/P Arrest w/ STEMI
  • STEMI  - >1 mm STE at the J point in 2 contiguous leads or greater than 2 mm STE in 2 contiguous leads isolated to leads V2-V3; reciprocal depression makes diagnosis more likely but not necessary for diagnosis. 
  • RBBB - causes = ischemia, functional, iatrogenic 
      > Definition - QRS >120 ms; RSR' pattern v1-v3, slurring of S wave in lateral leads
  • Diagnosis of STEMI in the setting of RBBB does not require special diagnostic criteria.
  • Consider RBBB as the result of an anterior MI (LAD lesion) rather than as a “benign bystander.”
  • AHA recommends PCI for patients with aFMC-to-device time system goal of 120 minutes or less and fibrinolytics for patients > 120 minutes (FMC = first medical contact).
  • Using a cutoff of 20 minutes from arrest to ROSC captures 96% of survivors and achieves a survival rate of 82%.


Case 2 - Ear Pain and Facial Palsy
  • Gradenigo’s Syndrome: Triad of otorrhea, retro-orbital pain, and CN VI palsy (diplopia).
  • Consider Gradenigo’s in patients with a cranial nerve palsy in the setting of acute or chronic otitis media.

Case 3 - Ataxia and Headache after Rollercoster Ride
  • Wallenberg Syndrome- lateral medullary syndrome- is an acute infarct involving the lateral medulla oblongata
  • It is the most common brainstem stroke
  • Patients present with vertigo, facial numbness, dysarthria, dysphagia, ataxia, and cerebellar signs
  • Consider CNS pathology in patients presenting with neurologic complaints after a roller-coaster ride
0 Comments

Rocky Mountain Spotted Fever - Dr. Schneider

5/29/2014

0 Comments

 
Picture
  • School-aged kids are the most likely to get RMSF!
  • North Carolina has the most cases in the USA.
  • Summer time + Headache + Fever +/- rash / exposure = Just treat, because time is of the essence.
  • You can perform LP or not.  Depends on your index of suspicion for other forms of meningitis. CSF is not helpful in the diagnosis of RMSF, but it can help rule-out other conditions.
  • Doxy is not the Devil!  Children can have a full course of doxycycline and not ruin their teeth.  

0 Comments

M&M - Dr. Bronner

5/1/2014

0 Comments

 
Picture
Thyrotoxicosis and Cardiomyopathy

  • Hyperthyroid effects on the cardiovascular system are not the same as hyperadrenergic states
  • Direct effects on vascular smooth and cardiac tissue leads to:
    1. Decreased SVR
    2. Decreased diastolic BP = Decreased afterload
    3. Activation of Renin-Angiotensin-Aldosterone = Increased Preload
    4. Direct cardiac inotropy + chronotropy
  • Ultimately, increased CO (HRxSV) that can lead to HF and dysrhythmias
    1. May be catastrophically precipitated by stressors such as sepsis 
  • Treatment of Thyroid Storm
    1. B-Blockade
    2. Thyroid Inhibition
      1. Synthesis  -   PTU or Methimazole
      2. Release   -   SSKI
      3. Periph Conversion (T4 to T3)  -   Hydrocortisone
HIV and PID

  • Suspect HIV in any severe febrile illness without a source
  • Know emerging demographics - Minority, heterosexual, women
  • PID treatment in HIV+ patients has similar approach and outcome as HIV-
    1. HIV+ may be more likely to develop TOA
  • IUDs are do not predispose to PID after the first 3 weeks post-placement
  • Usual culprit : Actinomyces, but treat for GC/CT!

0 Comments
<<Previous

    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