Tuesday

Advanced Practice: Duration of Prednisone Therapy for Severe Poison Ivy!

Oral steroids are a mainstay of treatment for severe posion ivy induced contact dermatitis. The doses, duration of therapy, and taper/nontaper debate has raged for decades: read on a for quick summary of a paper comparing a short steroid burst to a 15 day taper!

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Advanced Practice: High Flow Nasal Canula in Pediatrics!

You are caring for a 2 yo with multifocal pneumonia who is hypoxic on standard nasal canula. You decide to institute high flow nasal canula (HFNC) in an effort to stave off orotracheal intubation. Your repspiratory therapist requests parameters including flow rate (typically 0-40 LPM). What is the optimal flow rate to decrease work of breathing in this pediatric patient?

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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 Topics - Extra Epinephrine for Anaphylaxis in the Wildnerness

This three-minute video could help you one day save a life while hiking! It demonstrates how you can obtain and use additional doses of epinephrine from a single use epinephrine auto-injector in an emergency situation in which there would be a delay to definitive medical care.

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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 - Practice Changing Landmark Peds DKA Study!

For decades now, aggressive fluid replacement in pediatric DKA patients has been thought to contribute to cerebral edema and neurologic injury. This has resulted in a general policy of cautious fluid replacement with isotonic crystalloid, and perhaps even contributed to under-resuscitation of these patients. In this first large, randomized, prospective study to examine the role of type of fluid (0.9% NaCl vs 0.45% NaCl) and rate of administration, the hope was to detemine if type of fluid, rate of adminstration, or both were associated with cerebral edema and neurologic injury in this patient population. Read on for the key results of this practice changing paper!

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