Demographics![]()
Assessment
Ambulatory Asthma
Severe AsthmaClear Benefit
Possible Benefit
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PE in PEDs![]()
Oral Lichen Planus
URachal Cyst
![]() Case 1: Venous Sinus Thrombosis - Headache evaluation should always include: 1. Fundscopic exam 2. Posterior circulation- gait, coordination, speech 3. Cranial nerve exam 4. History for HIV, immunosuppression, thrombophilia - Venous sinus thrombosis 1. Largest risk factor is in young females (presumed secondary to pregnancy and OCPs) 2. Sx can range from severe headache only, to coma 3. Only 1/3 have neurological deficit 4. Diagnosis by either CT venography or MR venography (MR will give more information regarding edema and effects if clot if present) Case 2: Tension Pneumothorax following CPR - Always look at CT C spine or other studies that offer extra views of the lungs. Occult pneumothorax Is a frequently missed radiological entity because the radiologists are not looking for it. - Protective ventilator strategies reduce risk of barotrauma 1. Tidal volume 6-8 ml/kg of predicted body weight (Always calculate predicted weight!!!) 2. Plateau pressure less than 30 mmH2O 3. Accept lower oxygen saturation - Anytime a major hemodynamics change occurs, a FULL assessment should be performed and documented Personal Protection is NO JOKE! (but it can be fun.)
Always have your buddy to watch your back! PPE can make you STRONGER! ![]()
![]() 1. For patients diagnosed with a presumptive TIA, it is relatively common to have infarction demonstrated on DWMRI within the first 24 hours (~33% overall and 30-50% for any time epic within the first 24 hrs). 2. Based on a Scientific Statement issued by the American Stroke Association in 2009, a Transient Ischemic attack (TIA) is best defined as a transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction (Easton JD et al. Stroke 2009;40:2276-2293). Importantly, no symptom duration limitation is specified in this revised definition. 3. Pure sensory syndromes involving the contralateral face, arm, and/or leg have been described in both ischemic and hemorrhagic thalamic stroke, but these are relatively uncommon and the prevalence of TIAs isolated to the thalamus is unclear. ![]() Traumatic Brain Injury Management
Blunt Aortic Injury
Pelvic Fractures
Penetrating Neck Trauma
Why it Matters![]()
Intranasal Fentanyl
Nitrous - It's NOt Just for Dentists!
NEonates Feel Pain too!!
![]() Approach to the Ambiguously Sick Neonate THE MISFITS T - trauma H - heart E - endocrine M - metabolic (electrolyte imbalances) I - inborn errors of metabolism S - sepsis F - formula mishaps I - intestinal catastrophes T - toxins/ poison S - seizures More Pearls In the sick neonate have a low threshold for: - EKG, placing NG/OG, considering steroids, considering prostaglandins, considering upper GI series, and DONT TAKE YELLOW PUKE FOR GRANTED (yellow is just a mild shade of green). ![]() Radar: Who - Previous heart valve damage, prosthetic valves/cardiac device, congenital heart disorders, previous diagnosis of IE are highest risk factors. *Don't forget: Poor dentition, HIV, IV drug users, chronic hemodialysis What - Fever, murmur, cerebral/renal/splenic complications. Classic IE lesions - Janeway, Osler, Roth spots, splinter hemorrhages - much less common, <10%, but more specific to IE. Actions: ECHO - in search of vegetations Blood cultures - x3, will help identify 90% organisms Antibiotics - unasyn and gentamicin for native and prosthetic valve. Vancomycin/daptomycin for suspected IV drug users/MRSA. CT Surgery - emergent call for hemodynamic compromise |
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