May 5, 2021

Take Home Points
  • There is no strict golden hour for wound closure. Location, contamination and patient factors all should be taken into account
  • Dog bites can be closed primarily. Bites on the hand and foot are higher risk for infection. If you close, strongly consider adding antibiotic prophylaxis
  • Sterile water is unnecessary for wound decontamination as are additives (ie betadine). Tap water under reasonable pressure (45 psi) is adequate.

April 28, 2021

Background: It has long been thought that intravenous contrast can lead to acute kidney injury. Recent data, however, has called this dogmatic teaching into question.  Unfortunately, the data arguing against the association of contrast with AKI comes from observational trials and, thus, carry with it numerous biases.  One potential bias is baseline differences in the risk between exposure groups with patients not receiving contrast perceived to be at higher risk and those receiving contrast at lower risk of PC-AKI. Another example is selection bias due to requiring subsequent renal function testing in patients deemed to be higher risk and not those at lower risk.  Both of these can form a control group at high risk of kidney injury which creates a bias in favor of contrast and potentially masking harm.

April 7, 2021

Take Home Points
  • Altered mental status has numerous possible etiologies. Splitting it into vital sign issues, toxic/metabolic, infectious processes, CNS issues (bleed, mass) and psych/dementia is a good way to organize your thoughts
  • Hypertensive encephalopathy is a diagnosis of exclusion - make sure you're not dealing with another process like meningitis or an intracranial hemorrhage
  • Once the diagnosis of hypertensive encephalopathy is made, shoot to lower the SBP by about 20-25% over the hour using a drug like nicardipine, clevidipine or labetalol