![]() 1. All febrile SCD patients get the same initial work-up: H&P, CBC with diff, retic, and BCX 2. ACS = CTX + macrolide (+/- O2 and blood) 3. ACS more likely to develop inpatient... use good pulmonary toilet to prevent 4. Always check the spleen 5. Disposition criteria: home vs. 24H follow-up
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![]() 1. Be wary of atypical respiratory symptoms 2. Don't be afraid of imaging in the right setting 3. If you are concerned about mediastinal mass, image and admit 4. If you have a patient with mediastinal mass and increased work of breathing but they are relatively stable, leave them alone 5. If forced to intervene, try prone position and call for help ![]() Pseudoaneurysms - Definitions: 1. Outpouching of a blood vessel, involving a defect in the 2 innermost layers (tunica intima and media) with continuity of the outermost layer (adventitia) 2. Alternatively, all three layers are damaged and bleeding is contained by blood clot or surrounding structures - Etiologies are multifactorial, including post traumatic, iatrogenic (post catheterization), infection and inflammation, IV drug use, septic emboli and MI - Clinical Presentation: - Increased swelling which may be pulsatile over site of previous needle puncture, surgery or trauma; Anemia in cases of significant blood loss; significant pain - Look for characteristic yin yang sign on doppler - EAST Guidelines in Trauma: - Level 2 recommendation: Patients without signs of hard vascular injury who have abnormal physical examination findings and or ABI <0.9 should have further evaluation to rule out a vascular injury - Consider vascular imaging in patients with delayed (>1wk) bleeding, pain or swelling after a traumatic injury Hiccups: - An involuntary, spasmodic contraction of the diaphragm and intercostal muscles. Diaphragm contraction results in sudden inspiration and ends with abrupt closure of the glottis, generating the “hic” sound - Thorough history and physical exam is key in patients with persistent hiccups (48h to 1 month) - Etiology is broad. Most common causes include GI (overeating, gastric distention, GERD); post operative; diaphragmatic processes (subdiaphragmatic abscess). - CNS processes are a more serious cause. In patients with neurologic symptoms, consider MRI imaging. Patients with dorsal medullary strokes can have hiccups for up to 1 year that are debilitating and recalcitrant to medications. Sign of Lesar Trelat - Explosive onset of multiple pruritic seborrheic keratoses - Rapid increase in size and number - Often have an inflammatory base - An ominous sign of gastrointestinal carcinomas - Most commonly pancreatic, stomach, liver, and colorectal Intoxicated with Chest Pain![]()
Infected Kidney Stone
![]() • Aortoenteric fistula is the abnormal formation of connection between the aorta and bowel, typically occurring the 4th portion of the duodenum. • Primary fistula formation due to atherosclerotic or infectious erosion of aorta into the bowel; secondary is the result of complications of aortic graft placement, either graft infection or pressure necrosis. • Typically present with “sentinel bleed” followed by massive GI bleed and hemodynamic collapse; classic triad occurs <25% of patients. • Vascular surgery consultation emergently if suspected; CT angiography can be helpful, but only after consultation and surgical evaluation. ![]() 1. Four recently completed trials demonstrate that early mechanical stent-thrombectomy after tPA in patients with large vessel occlusion and salvageable tissue on brain imaging results in improved reperfusion and functional outcomes. 2. The details of the patient selection paradigm remain a key discussion, but favorable penumbral imaging is a consistent feature of all trials. 3. Systems of acute care, including transfer protocols, will need to be re-organized to deliver this therapy effectively in the real world ![]()
![]() 1. Consider the possibility of preeclampsia in all women with hypertension regardless of gestational age, up until 6 weeks postpartum. 2. Proteinuria is no longer needed for the diagnosis of preeclampsia and the degree of proteinuria does not correlate with disease severity. 3. If features of severe preeclampsia are present, do not delay administration of IV magnesium. ![]() - Early recognition and treatment is critical.... give epinephrine EARLY and OFTEN - Treat anaphylaxis as a spectrum... as short as 2 hour observation up to admission - Steroid duration depends on who you ask. No good evidence to support or refute their use. - Vasopression for anaphylatic shock with suboptimal epi response. - Consider glucagon for those patients on beta-blockers. |
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