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M&M - Dr. Bronner

2/6/2014

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Picture
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


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... 

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
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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