Richard Byrne, MD

Advanced Practice: Fever and Hemolytic Anemia....in New Jersey...

  • A 50 yo male presents with severe fatigue, tactile temps, chills, fatigue, and dizziness for one week. The family also notes yellowing of his skin.  T is 102.3 oral. His labs demonstrate a Hgb of 8.8, platelets of 141, and TBili of 1.6 with a normal direct bili. Cr is noted to be elevated at 1.42 with a normal baseline. What is going on with this patient and whom should we call?
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Advanced Practice: Subcutaneous insulin for DKA!

You are treating a patient for diabetic ketoacidosis in the ED. Thing is, the patient isn't very ill and only has mild DKA (pH 7.25-7.3). Is starting a continuous insulin infusion and admitting the patient to an intensive care unit bed really the best use of resources? Read on for an alternative suggested regimen using subcutanoues doses of rapid acting insulin

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Advanced Practice - Practice Changing Landmark Peds DKA Study!

For decades now, aggressive fluid replacement in pediatric DKA patients has been thought to contribute to cerebral edema and neurologic injury. This has resulted in a general policy of cautious fluid replacement with isotonic crystalloid, and perhaps even contributed to under-resuscitation of these patients. In this first large, randomized, prospective study to examine the role of type of fluid (0.9% NaCl vs 0.45% NaCl) and rate of administration, the hope was to detemine if type of fluid, rate of adminstration, or both were associated with cerebral edema and neurologic injury in this patient population. Read on for the key results of this practice changing paper!

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Advanced Practice - Neutropenic Enterocolitis

Neutropenic Enterocolitis aka typhlitis, necrotizing enterocolitis, ileocecal syndrome

Definition:

  • intestinal mucosal wall edema and disruption of wall integrity in a neutropenic patient 

Pathogenesis:

  • Weakened immune system --> intestinal overgrowth --> invasion of opportunistic bacteria.
  • May lead to sepsis and bowel perforation.
  • Mortality  22%-50%.

Patient population:

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Advanced Practice - New Sepsis Guidelines Ignite Controversy!

The Surviving Sepsis Campaign has published a 2018 update to their guidelines for sepsis care. The new recommendations have sparked major controversy in the emergency medicine, critical care, and infectious disease communities. Read on for a brief summary of the most controversial points and links to further reading!

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Advanced Practice: New C-diff guidelines!

This week's post comes courtesy of our ED pharmacist Rachel Rafeq. Surprise! Metronidazole is no longer first line therapy for c-diff infections! Check out this handy table for the updated guidelines from the Infectious Disease Society of America for the latest treatment regimens

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Advanced Practice: Airway Mastery Series! DL vs VL for Airway Management in the ED

The ResusEM conference is coming back this August! This is a summary of a portion of Dr. Byrne's talk on airway management presented at the August 2017 ResusEM conference at Cooper Medical School of Rowan University. Check out some of the literature looking at the performance of video largyngoscopy versus direct laryngoscopy in various hospital settings.

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Advanced Practice: Airway Mastery Series! DL vs VL for Airway Management in the ED

The ResusEM conference is coming back this August! This is a summary of a portion of Dr. Byrne's talk on airway management presented at the August 2017 ResusEM conference at Cooper Medical School of Rowan University. Check out some of the literature looking at the performance of video largyngoscopy versus direct laryngoscopy in various hospital settings.

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