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![]() - 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. ![]() Thrombotic Thrombocytopenic Purpura: - Can be hereditary or acquired. Acquired forms can be found as a result of a multitude of disease states. - Patients will more often present with vague symptoms including confusion/AMS rather than focal neurologic deficits attributable to a specific vascular distribution. - Treatment to consider initiating in the ED includes steroids and FFP however be wary of volume in patients with underlying cardiac disease. - VasCath can be placed in ED depending on provider comfort. - Plasma exchange has decreased mortality from 85-95% to 10-20%. Third Degree Heart Block: - Most often seen in elderly patients due to progressive fibrosis and calcification of conduction system and surrounding tissue, but can certainly be a complication of AMI. - Particularly for your elderly patients, be wary of medication side effects. - Atropine is always worth a try. Just realize more often than not it won't help you. - Hypotension? Altered mental status? Distress? PACE THE PATIENT! - Take the time to review initiation of transvenous pacing. Like the infamous ED thoracotomy or cricothyroidotomy, its a procedure we should know like the back of our hands. Final Pearl: if you're going to order an imaging study, look at the WHOLE image. ![]()
![]() HYPOGLYCEMIA Presentation:
Not all patients recognize their own hypoglycemia well.
Some patients that are at high risk for hypoglycemia:
Treatment - we often do it wrong!
![]() Change in Mental Status and Abnormal Laughter
![]() Abdominal Pain in Pt who has MS and Drinks Everyday
![]() Change in Mental Status
![]() Pupura on Ears of Pt
![]() Actively Seizing Patient
Patient with hx of Sz who presents after Sz
New Onset Seizure Pt
![]() -NPH is a potentially reversible cause of dementia and early intervention can be life-changing for patients -The terms hydrocephalus and vetriculomegaly are not synonymous. All patients with NPH should have enlarged ventricles, not all elderly patients with enlarged ventricles have NPH. -Emergency department management should focus on maintaining a broad differential and managing post-shunt complications. ![]() Hypercalcemia - Hypercalcemia relatively uncommon in the ED, but highly correlated with cancer and poor prognosis - 25% of cancer patients - 50% die within a month of hypercalcemia dx - Severe levels can be life threatening - Renal failure - Dysrhythmias - Coma - Death - Occurs due to increased bone resorption and release of calcium - Bony mets release cytokines that break down bone - Tumors secrete PTHrP and an active form of Vitamin D, causing bone breakdown - Who to suspect: - Elderly - Acute confusion/MS change - Unexplained weakness - History of cancer -- especially breast, lung, lymphoma, or multiple myeloma - What to look for: - Neuropsych, GI and MSK à vague symptoms - Evaluate with serum calcium (must account for serum albumin and correct) or ionized calcium - Consider the clinical context and order additional labs/tests as necessary, including EKG and CXR Treatment Mild
Moderate
Severe
- Pamidronate – 60-90 mg over 2-24 hrs
- >18mg/dL - Renal failure - CHF |
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