Internal Medicine

Advanced Practice - Hyperleukocytosis syndrome!

A 58 yo patient with a hx of CLL presents with a chief complaint of dyspnea, wheezing, and cough for 3 days. He is noted to be tachypneic with o2 sats of 91% on RA. There is diffuse expiratory wheezing. Peripheral WBC count is 199,000, increased from a baseline of ~80,000. A CT scan shows scattered interstital infiltrates. What is going on with this patient and what is the indicated therapy?

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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: 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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