May 27, 2019

Background: In 2000, the U.S. achieved the elimination of measles, defined as the absence of sustained transmission of the virus for more than 12 months [3,7]. Unfortunately, this success was short lived.  According to the CDC, 555 cases of measles have already been confirmed from Jan 1st – April 11th, 2019 [3]. This resurgence in measles is frustrating as it has a safe and highly effective vaccine, and it has no animal reservoir to maintain circulation.  Failure to get vaccinated unfortunately stems from misconceptions about vaccine safety (i.e. the now-debunked claim connecting vaccination to autism [4,5]), poor health education, lack of access to health care, and complacency.  This is now a global epidemic as disease does not respect borders.

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 14, 2019

 

Essentials of Emergency Medicine 2019 is taking place at the Cosmopolitan Hotel/Casino in Las Vegas, NV. I was asked to give five lectures on varying topics and wanted to share what I discussed at each of these sessions.  If you haven't been to Essentials of Emergency Medicine, you need to add this conference to your list of conferences to attend.  The organizers pride themselves in discussing the latest practice-changing research and have meticulously designed content to maximize enjoyment and retention. In my humble opinion this conference is the quintessential medutainment extravaganza that applies learning theory principles, with amazing speakers, to provide you with the latest and greatest for clinical practice.

March 18, 2019

Background: With CMS core measures requiring timely use of antibiotics in patients with fever and suspected sepsis, many patients receive antibiotics up front that may ultimately end up having another non-bacterial etiology as the cause of their fever.  On the one hand overuse of antibiotics can increase bacterial resistance, healthcare costs, and potential side effects. On the other hand, withholding antibiotics from patients with bacterial infections can increase morbidity and mortality. The authors of this trial wanted to determine whether a procalcitonin-guided algorithm could be used to reduce antibiotic regimens in the ED.

March 11, 2019

Background: Based on the Surviving Sepsis Campaign, hemodynamic resuscitation of sepsis patients is done by repeating serum lactic acid levels every 2 – 4 hours until normalization. The issue with this strategy is that there are other things that may elevate lactate levels other than sepsis and hypoperfusion.  Another, potentially useful marker to guide hemodynamic resuscitation could be capillary refill time.  Its easy-to-use, requires no resources, and costs nothing.  To answer this question the ANDROMEDA-SHOCK randomized controlled trial tried to evaluate the use of a peripheral perfusion-targeted resuscitation strategy during septic shock in adults.
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