November 11, 2020

Take Home Points
  • Watch for continued bleeding in excess of 500 ml or bleeding that is “more than normal.” Call it postpartum hemorrhage and start resuscitation
  • Call your obstetric and/or surgical consultants early as operative intervention is often required
  • Replace intravascular volume with blood products
  • Uterine atony is the most common cause of postpartum hemorrhage. Begin treatment with uterine massage and uterotonic medications
  • Consider the development in DIC when patients continue to bleed despite appropriate management

November 9, 2020

Background/Introduction: The use of Sodium Bicarbonate (SB) in cardiac arrest has had a complicated history with strong and varied opinions on its effectiveness. SB was recommended in earlier ACLS guidelines, mostly stemming from the notion that severe metabolic acidosis due to hypoxia and hypoperfusion during cardiac arrest led to impaired myocardial contractility, decreased effectiveness of vasopressors, and increased risk of dysrhythmias. Subsequent data called into question the benefits of SB in cardiac arrest and highlighted potential harms such as hypernatremia, hyperosmolarity, metabolic alkalosis, as well as reduction in ionized calcium, vascular resistance, and extracellular fluid volume expansion. This led to the 2010 ACLS guidelines stating that routine use of SB is not recommended (Class IIIB) and that it may be considered in special circumstances (preexisting metabolic acidosis, Hyperkalemia, or TCA overdose). Despite this, the use of SB during cardiac arrest is still common in emergency departments with varying opinions on its effectiveness. In fact, recently published data from the National Emergency Medicine Services Information System (NEMSIS) noted that besides epinephrine and normal saline, sodium bicarbonate was the third most commonly used medication in out of hospital cardiac arrest (Chan 2020). This study aimed to consolidate the state of evidence behind the use of SB in cardiac arrest.

November 6, 2020

Babesiosis

Epidemiology Incidence:
  • Overall annual incidence rose from 0.6 to 0.9 cases per 100,000 in the United States between 2012 and 2015 (Gray 2019)
  • Annual incidence is highest in those between 60-69 years of age (Gray 2019)
Age:
  • Median age is 63 years of age with greater than 89% of cases reported in Caucasian patients (Gray 2019 2010)
Gender:
  • Male to female predominance (Gray 2019)

November 5, 2020

Rocky Mountain Spotted Fever (RMSF)

Epidemiology Incidence:
  • Overall annual incidence rose from 1.7 to 7 cases per million in the United States between 2000 and 2007 (Openshaw 2010)
  • Annual incidence is highest in children aged 5-9 years of age (Amsden 2005)
Age:
  • Median age is 42 years of age with greater than 87% of cases reported in Caucasian patients (Openshaw 2010)
Gender:
  • Slight male to female predominance (Openshaw 2010)

November 4, 2020

Ehrlichiosis

Epidemiology Incidence:
  • Overall annual incidence noted to be 3.2 cases per million in the United States between 2008 and 2012 (Biggs 2016)
  • Highest incidence occurs in those 60-69 years of age (Biggs 2016)
Age:
  • Median age is 55 years of age with 64% of cases reported in Caucasian patients (Heitman 2016)
Gender:
  • Slight male to female predominance (Heitman 2016)