Internal Medicine

Advanced Practice: Zebras in the ED

24 y/o F visiting from Guatemala with no medical history presented to the ER after a syncopal event from standing during which she fall backwards hitting her head on a hard surface. Patient was witnessed to be shaking while on the ground per family member. She continued to feel dizzy while in the ED. Her lab work was normal and a head CT was performed which showed the following:

 

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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 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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Board Review: Infectious Disease

A 60-year-old male presents with fever, dry cough, headache, nausea, vomiting and diarrhea. He saw his primary care physician who prescribed him Amoxicillin for which he has been taking for 4 days but feeling worse. Labs show a Sodium of 130 and mild transaminitis, other labs are within normal limits. What is the most likely diagnosis?

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