Internal Medicine

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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Board Review: Yellow Fever

A 45 year old male presents to your emergency department with 1 day of headache, body aches, nausea and vomiting?  On further history you learn that the patient recently returned from a trip to Africa and you suspect Yellow Fever.  Which of the following below would increase your suspicion for Yellow Fever? (scroll down for the answer) 

A) Low pulse relative to fever  

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Advanced Practice: sPESI vs Hestia Criteria for Discharge of Low Risk PE Patients

With the rise in popularity of the NOAC class of anticoagulants, more and more patients with a new diagnosis of pulmonary embolism are being discharged from the emergency department.  Multiple risk classifications tools have been developed to help identify patients at low risk of short term mortality. Read on to see if this new study determined which tool is the winner!

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Board Review: Crush Injury

A 30 year old mechanic presents for a right lower leg injury. He was working on his car when it fell on his right leg. Urinanalysis reveals dark urine with a dipstick positive for large mount of blood. Serum CK is 28,000 units/L. The primary treatment modality is: 

A. Sodium Bicarbonate

B. Furosemide

C. Mannitol

D. Normal Saline

E. Calcium Gluconate

 

 

 

 

Answer is D - Normal Saline

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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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Board Review: Infectious Disease

A 52 year old male with history of asplenia after a car accident presents with a fever for 8 days. Tmax is 101.8. Denies any other symptoms. Denies rash. Reports he walks every morning through a path in the woods behind his house. Denies recent travel, animal exposure, sexual history. Blood pressure is 120/80, heart rate is 110, Temperature is 101.0 F, respiratory rate is 18, SpO2 is 100% on room air. Physical exam is otherwise unremarkable. Blood work is significant for evidence of hemolytic anemia and peripheral smear shows maltese cross. What is the next step in management? 

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#EMConf: Management of Tick Borne Illnesses

Consider tick borne illness when:

  • Influenza-like illness presentations, especially during the summer months. 
  • Fever of unknown origin
  • When viral meningitis is on your differential diagnosis. 

Babesiosis:

  • PO: Atovaquone + Azithromycin
  • IV: Clindamycin + Quinine
  • Exchange transfusion indications (would need Hematology/Oncology consult): 1. Asplenia       2. Parasite Load > 10%

Lyme's Disease:

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