M&M - Dr. Keller

62 yo with Facial Swelling

Strep Toxic Shock Syndrome

• Group A Strep is less commonly invasive, but... can be.
• Mortality rate is 30-70%
  

Diagnostic criteria for Strep Toxic Shock Syndrome:

• Positive culture AND SBP <90 PLUS 2 of the following:
• Renal Impairment
• Coagulopathy
• Liver involvement
• ARDS
• Erythematous Rash
• Soft tissue necrosis
  

Tx:
Clindamycin  (to stop toxin synthesis)  AND
Carbapenem or Zosyn
Vancomycin

IVIG - maybe useful

All this and Smart too.

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23 yo with Headache --- and she's Pregnant

PreEclampsia

• Must be ruled out in pregnant patient with Headache
• Can occur from 20 weeks gestation up to 6 weeks post-partum
• ALWAYS check fetal heart rate!  There is another patient who has vital signs that you need to consider!

Catecholamine-Secreting Tumors

• Triad of HA, sweating and palpitations present in only 40%
• Pheochromocytomas secrete epi, found on adrenal gland
• Paraganglioma secretes norepi
  

• Medications like Reglan, morphine, glucagon, and steroids can precipitate hypertensive crisis!

• Pheo in pregnancy- orthostasis and worsening HTN when supine; increased maternal and Fetal mortality.
• Therapy = Phenoxybenzamine is the drug of choice for pheochromocytomas in pregnancy

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Swollen Leg

Phlegmasia

• Phlegmasia Alba Dolens- clot in deep veins

• Phlegmasia Cerulean Dolens- clot in deep and superficial collateral veins; needs rest, elevation, anticoagulation, and thrombectomy- not your standard DVT

Spectrum of DVT

• DVT--> PAD--> PCD with worsening severity

Consult Vascular Surgery and Orthopedic Surgery (call everyone and call quickly).