Tuesday

Advanced Practice: Catheter Associated Asymptomatic Bacteriuria and Urinary Tract Infections

59-year-old male with prostate cancer status post laser therapy (POD 14) presents with hematuria (bright red blood and clots) and difficulty urinating. Post void residual volume is 400cc. Urinary catheter is placed. Hemoglobin is stable and patient would like to be discharged with follow up with urology in 2 days. Should patients be placed on prophylaxis systemic antibiotics?

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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 - Calcific Tendonitis Can Mimic Septic Arthritis!

A 63 yo male presents complaining of severe pain to the right shoulder. He has markedly restricted range of motion in the shoulder, without any overlying erythema, edema, or warmth. You take a cursory glance at the xray as you gather supplies to perform an arthrocentesis for suspected septic arthritis...

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Advanced Practice - My Patient Hearing Opera Singer in Right Ear

An 82 yo male presents to the ED complaining of several months of progressive hearing loss in the right ear. For the past 3 days, he can hear a male voice singing opera in the right ear only,  24/7. Read on for a brief discussion of this fascinating phenomenon and how we cured him in 5 minutes!

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Advanced Practice - Missed Orthopedic Injuries in the ED!

Check out this lateral film of the wrist. See the fracture? Look again! Surprise...there is no fracture, but this patient has sustained a serious wrist injury with the potential for long term disability. This week we highlight some of the most common missed orthopedic injuries in the ED and suggest a few strategies to minimize the errors.

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Advanced Practice: Thoracic Central Venous Obstruction!

A 25 yo male with a hx of ESRD due to membranoproliferative glomerulonephritis (MPGN) presents to the ED with complaints of swelling to his LUE, face, and neck progressive over 5 days. He was seen at another ED 2 days prior and had an ultrasound of his LUE fistula as well as a duplex of his LUE which were unremarkable.  A CT scan of the chest was ordered, revealing bilateral occluded brachiocephalic veins, which were treated in the interventional radiology suite with balloon venoplasty with resultant resolution of edema.

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Advanced Practice: Lemierre Syndrome

Lemierre Syndrome is thrombophlebitis with infectious involvement of the carotid sheath vessels and bacteremia.  It is an extremely rare condition also known as jugular vein suppurative thrombophlebitis, postanginal sepsis and necrobacillosis, which usually affects previously healthy / young adults (approx. 20 y/o).  

 

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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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