June 12, 2019

Take Home Points on Measles

  • There is a resurgence of measles worldwide
  • Incubation period is 10 – 14 days and patients are contagious 4 days before rash develops and up to 5 days after
  • Suspect measles in any patient with an acute febrile illness who is either un- or undervaccinated
  • Know about Post Exposure Prophylaxis (PEP) schedules and isolation times of various populations
  • Healthcare workers should wear N95 masks while taking care of patients with suspected measles, and report cases to their local health department.

May 30, 2019

Background: Syncope, defined as a transient loss of consciousness with spontaneous and complete recovery to pre-event status, is a common emergency department (ED) presentation. Recently, we have discussed the lack of clinical utility in distinguishing syncope from near-syncope in terms of outcomes. In that discussion, we concluded: “In older adults (> 60 years of age), near-syncope appears to portend an equal risk of death or serious clinical event at 30 days when compared to syncope. These two entities should be considered as one when decisions are made in terms of evaluation in the ED.” While we argue for evaluation and disposition to be the same, we don’t address what the best disposition or plan is. While it is common to admit older patients with syncope/near-syncope from the ED, admission doesn’t inherently yield better outcomes.

May 29, 2019

Take Home Points on Tracheostomy Emergencies

  • Track is mature in 7 days - don't blindly replace before then because concern for false track creation
  • All bleeding needs to be taken seriously and should be evaluated by surgery
  • If not ventilating through trach - go through it systematically to find malfunction

May 15, 2019

Take Home Points on Epiglottitis

  • Epiglottitis has demonstrated a resurgence in the adult population. It is no longer a pediatric only disease.
  • The classic presentation of epiglottitis (3Ds of drooling, dysphagia and distress) is uncommon
  • Epiglottitis should be high on your differential for the bounce-back patient who continues to complain of worsening sore throat
  • Definitive diagnosis is made by flexible fiberoptic laryngoscopy
  • Be ready for a difficult airway

May 1, 2019

Take Home Points on Blunt Cardiac Injury

  • No single test can be used to exclude BCI. However a thorough physical exam combined with a 12-lead EKG, troponin measurement, and echocardiography can be used to characterize BCI and direct care
  • Obtain a 12-lead EKG in all thoracic trauma patients 
  • A chest x-ray may help to identify associated injuries. However, isolated musculoskeletal injuries such as sternal fractures do not correlate with a risk of BCI
  • Bedside TTE can quickly evaluate for life-threats such as cardiac tamponade; A TEE is both sensitive and specific across the spectrum of BCI pathology and is part of a comprehensive evaluation
  • BCI can be excluded in a patient without EKG abnormalities and a negative troponin I
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