Conference Notes 1-17-2018
Kernicki-Sklar Study Guide Infectious Disease
Severe sepsis is defined when the patient has any sign of organ failure including elevated lactate, altered mental status, and elevated creatine among many signs. Septic shock is a lactate >4 or a MAP<65 after 30ml/kg of fluids. Start norepi if patient has shock.
Bed bug bites tend to be in a line. They are intensely pruritic. There is no infestation on the patient meaning the patient is not carrying bed bugs. You can not get bed bugs from touching the patient. The bed bugs live on the mattress or other places in the house.
Occular syphillis can have red spots on iris.
Secondary syphilis rash can take many forms. If you see a rash on the palms or soles think syphilis. Condyloma lata or syphilitc warts are extremely contagious.
Typical areas of scabies infection. Patients with scabies, unlike bed bugs, do have a mite living in/on their skin and can transmit scabies by direct contact. Treat with permethrin cream.
Strawberry Cervix of Trichomonas Infection
Anna spoke about the new recommendations for antibiotic prophylaxis to prevent endocarditis. The only procedure in the ED you may want to consider giving prophylaxis for is draining an intra-oral abscess in a patient with high risk of endocarditis (prosthetic valve, prior infective endocarditis, and patients with un-repaired congenital heart disease or congenital heart disease repaired with prosthetic material)
The diagnosis of necrotizing fasciitis may not be apparent upon first seeing the patient. Overlying cutaneous inflammation may resemble cellulitis. However, features that suggest involvement of deeper tissues include (1) severe pain that seems disproportional to the clinical findings; (2) failure to respond to initial antibiotic therapy; (3) the hard, wooden feel of the subcutaneous tissue, extending beyond the area of apparent skin involvement; (4)systemic toxicity, often with altered mental status; (5) edema or tenderness extending beyond the cutaneous erythema; (6)crepitus, indicating gas in the tissues; (7) bullous lesions; and 8) skin necrosis or ecchymoses. (IDSA Guidlines 2014)
IDSA Antibiotic Recommendations for Necrotizing Fasciitis
Lambert U/S DVT
You need to use a high frequency linear probe to scan for DVT.
The main sign of DVT is non-compressibility of the vein.
Common femoral vein that compresses normally
Transverse views of popliteal vein with DVT. Note that on the right side image even with compression the vein does not collapse. The orientation of the vein in the popliteal fossa is always superficial to the popliteal artery. Hence "Pop on Top"
Lambert MSK Ultrasound
95+% of Rotator Cuff Injuries affect the supraspinatus muscle. The supraspinatus muscle abducts the humeurs. You can use ultrasound to identify suprasinatus tears.
U/S can identify hip effusions as seen above.
Ultrasound can be used to identify tendon ruptures
Lambert and Team Ultrasound DVT & MSK U/S Workshop
Awesome U/S Workshop in our new Sim Lab.