Internal Medicine

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: 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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