Conference Topics 8-2-2011

8-2-2011  Conference Notes
Peds Study Guide  Bill Schroeder
Persistent unilateral nasal drainage, think nasal foreign body.
Unilateral air trapping on expiratory films points to an aspirated fb. 
Throat culture for strep has a 10% false negative rate.  Traditionally it is accepted that abx tx for strep throat shortens course of illness and prevents rheumatic fever.   (there is some debate about the significance of both these rationales)
Strep throat is uncommon under age 3 because kids at this age lack the necessary protein in the throat that binds strep. 
SIDS is due most frequently to an asphyxation event.  Basically child is suffocated by prone sleeping position or sleeping in bed with parents.
Diagnosis of acute otitis media depends on effusion (distortion of tm) and inflammation (injection).  Light reflex is not significant for diagnosis.  Insufflation is the best for diagnosing aom but is difficult. 
Crying infant think corneal abrasion
Conjunctivitis after erythromycin topically in infants think chlamydia and give oral erythro or azithro.
50% of EP's are employees of a hospital
Additional career challenges other than clinical EM promote longevity in the specialty.
If you leave clinical medicine, it is hard to make equal or more money.  You are paid very highly for your clinical work. 
Invest in quality disability insurance.
When you look at a new group to join, ask how they are doing with their quality measures.  Do they use them to decide on your salary?
 Does the group have a good position in the hospital to get their share of bundled payments. 
More people are on medicaid then medicare. 
10,000 baby boomers enter medicare a day for the next 19 years with no added funds.
PEA :  Hypovolemia, Hypoxia, Hyper/Hypokalemia, Hypothermia, H+(acidosis)   Toxins, Tension Pneumo, Tamponade, Thrombosis (PE,AMI)
Keryon is a large boggy mass on scalp that is caused by tinea capitis.  Do not incise.  Treat with griseofulvin or diflucan po. 
I and D of pilonidal cyst stay just lateral to the midline for improved wound healing.
For Bartholin's Abscess, word catheter stays in for 4-6 weeks. 
Consider necrotizing fasciitis when pain is out of proportion to exam. 
Preseptal cellulitis: no impaired eom, no proptosis, no pain with eom, 
Augmentin or Clinda/bactrim or clinda/cipro for mammilian bites.
Id reaction: pt has a fungal infection on foot or hand and due to circulating antigen and  pt develops rash on a remote site of body.
Surogates Rank order: Guardian/ Spouse/ Adult Child/ Parent/ Adult Sibling/ Close Friend
Withdrawl of Care: Can't pull ET tube without being sure neuromuscular blockers and major sedatives are out of patient's system.
The LET form is important.  Fill it out please in the ED!