Reid Phillips MD

Advanced Practice: Vaginal Cuff Dehiscence and Evisceration

Vaginal Cuff Dehiscence and Evisceration After Total Hysterectomy

Incidence of vaginal cuff dehiscence after hysterectomy ranges from 0.14-4.1%.

Risk factors include post-operative infection, radiotherapy, chemotherapy, early return to sexual intercourse, constipation

Surgical emergency with risk of bowel necrosis.

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Advanced Practice: Stercoral Colitis with Obstructive Acute Kidney Injury

An elderly female patient presents with abdominal pain and distention with no bowel movement in 1 week. Labwork shows a Cr of 8 from baseline of 1 with a normal lactate.  Click for further information about her diagnosis. 

 

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Advanced Practice: Acute Febrile Neutrophilic Dermatosis

A 50 year old male with a recent lung mass resection presents with chills and diffuse burning rash.  Patient was well appearing and afebrile. There were no mucosal lesions. Initial lab testing was significant for a leukocytosis of 19 with 89% neutrophils. Patient was started on steroids and observed in the hospital. 

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#EMConf: Reversal of Lovenox

Recommend against reversal of LMWH in patients receiving prophylactic dosing of LMWH. 

Low quality of evidence for the use of FFP or PCC to reverse LMWH. 

Protamine:

  • Dosed within 8 hours - 1 mg IV per 1 mg Lovenox (up to 50 mg in a single dose).
  • Dosed within 8-12 hours - 0.5 mg IV per 1 mg Lovenox (up to 50 mg in a single dose). 
  • Minimal utility in reversal of >12h from dosing. 

rFVIIa: 90 ug/kg iV if Protamine is contraindicated. 

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#EMconf #FlyEaglesFly: FFP for ACE-I induced angioedema

While the Cooper EM residents and faculty not on duty flock to the Eagles Super Bowl celebration parade in Philadelphia, EMDaily presents a brief review by our own Dr. Reid Phillips of two articles examining the efficacy of fresh-frozen plasma for the treatment of ACE-I induced angioedema. Can this simple therapy help prevent an airway disaster? Read on to find out!

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#EMconf: Antibiotics Necessary for Uncomplicated Diverticulitis?

Patients suffering from uncomplicated diverticulitis are generally prescribed oral antibiotics but does it improve outcomes?  This week for his critically appraised topic,  Dr. Reid Phillips investigated whether antibiotics improve recovery time or complication rate in uncomplicated diverticulitis.