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![]() Lip and facial swelling - Angioedema to the Max!
Our New Scope is found in Room 1 of pixis- "endoscopy storz'. Attached to cmac to black plug, ![]() 29 yo bilateral leg pain Lactic acidosis
1. Resusucitate/supportive care 2. Identify cause with appropriate lab ordering 3. Empirically give Thiamine 500mg IV 4. Consider empiric Fomepizole after tox consult 5. Sodium Bicarbonate is controversial 6. When in doubt, call nephrology and dialyze Alcoholic KetoAcidosis -- Heavy etoh use with a recent binge, sudden cessation with abd pain, N/V. GI symptoms seen in 80%. -- Present with Absent ETOH level and Anion Gap metabolic acidosis. -- Due to increased betahydroxybutyrate ketone body, UA does not pick up ketone bodies on dip. -- Rarely will see severe lactic acidosis and if present think sepsis, seizures or thiamine deficiency. Tx:
Thiamine deficiency Pyruvate cannot enter TCA cycle causing high lactic acidosis resulting in Dry (neurologic) and Wet (cardiac) Beriberi. Also causes Wernicke (triad of AMS, opthalmoplegia, and ataxia seen only in 10% of patients). At risk- etoh, iatrogenic, aids, malignancy, gastric bypass, TPN 44yo fall from standing
Liver Function Tests are more indicative of liver damage... not "function."
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Congenital Adrenal Hyperplasia
Always consider adrenal insufficiency in hypotensive patients who remain hypotensive despite appropriate fluid resuscitation and initiation of pressors (whether adult or pediatric)... but particularly think of it in neonates!!
2) Age-based - 0-3 yo: 25mg IV; 3-12 yo: 50mg IV; >12 yo: 100mg IV 3) Randy's Rules (from the brilliant mind of Dr. Cordle) - Give at LEAST 25mg; 3x their current dose; or 2mg/kg
-- Limitations - requires patient cooperation, not definitive airway. -- Intubate when the above doesn't work - but increased morbidity and mortality with intubation
- Respiratory rate - Short inspiratory time - I:E ratio 1:3 to 1:5 Delayed sequence intubation
10 day old with vomiting
- Hx of "GERD" since day of life 4; Mom GBS + but treated and baby full term without complications; +constipation - Green emesis day of presentation - looks great at bedside - Neonate with Bilious Emesis - KEEP IT SIMPLE... Neonate with Bilious Emesis = Badness until proven otherwise. -- Surgical vs non surgical - Surgical includes duodenal atresia, malrotation with volvulus, NEC. Also consider Sepsis. Malrotation - arrest of normal rotation of embryonic gut > usually presents in infancy -- >50% of kids will present before one month of age -- >90% have vomiting - it won't always be bilious -- > Urgent surgical consultation if kid looks bad - Imaging -- Plain films - not sensitive or sepcific - May see double bubble sign -- Upper GI = study of choice
Conjunctivitis: Allergic, viral, bacteria
Uveitis: inflammation of iris, ciliary body, choroid
Acute closed angle glaucoma: emergency need to make dx, can have visual loss.
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