M&M - Dr. Bronner

Pneumococcal Meningitis with HUS

Usually serotypes outside of 13-valent vaccine
If you suspect, initial treatment with:        - Cefotaxime 300 mg/kg/day IV (max 12g/day) in 3 doses OR
        - Ceftriaxone 100mg/kg/day IV (max 4g/day) in 2 doses PLUS
        - Vancomycin 60mg/kg/day IV (max 4g/day) in 4 doses

Pneumococcal HUS
Recognize classic triad: 
        - Microangiopathic hemolytic anemia
        - Thrombocytopenia
        - Acute Kidney Injury
Sources:
        - PNA - 70%
        - Meningitis - 20-30%
        - Others - Otitis, sinusitis, bacteremia

        - Not like STEC-HUS
        - Needs Tx with Abx
        - Pneumococcal leads to higher M&M

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Hemoptysis from 5-yr old retained GSW
Delayed Pulmonary Hemorrhage from FB
        - Up to 30 yrs latency reported
        - Present with intermittent hemoptysis

Complications:
        - Pulm Art or Aortic Pseudoaneurysm
        - AVMs with R -> L shunts
        - Embolization - arterial or venous

Massive Hemoptysis
No universal definition - "Is this life threatening?"

Initial ED Management
        - ID bleeding lung and position dependently
        - A - Establish airway (8-0 ETT or bigger for bronchoscope)
        - B - Ensure good gas exchange on vent
        - C - Stop bleeding!  Restore volume, give PRBCs, reverse coagulopathy,etc... 

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Regular Wide Complex Tachycardia
        - Consider VT until proven otherwise!!!
        - 80% is VT by numbers
        - Algorithms to differentiate SVT are difficult to remember
        - If you treat for VT, won't harm SVT
        - Nodal blockers for SVT can send VT into VF -- PLACE PADS with Adenosine!

    A great analysis of EP and Cardiologist failure in applying Brugada to electrophysiologically proven VT.  
    Two fantastic talks from the ever-salient @amalmattu
        - VT vs SVT with Aberrancy
        - Adenosine Sensitive VT