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

April 3, 2019

Take Home Points on Non-Inferiority Studies

  • Non-inferiority studies should be done when a new treatment (or diagnostic modality) requires less resources (cost or time), is easier for the patient or has a lower side-effect profile.
  • Non-inferiority study design largely negates the protections against bias added by blinding and randomization.
  • Non-inferiority studies can be used to manipulate clinicians when a superiority study would be more appropriate.

March 20, 2019

Take Home Points on Oncologic Emergencies:

  1. Hyperviscosity Syndrome happens when elevated WBCs or severe hyperproteinemia cause high serum viscosity and micro-circulatory problems in patients with Waldenstrom’s macroglobulinemia, multiple myeloma or acute leukemia. Be suspicious of this syndrome in these patient’s when they present with the classic triad of mucosal bleeding, visual disturbances, and neurological symptoms or with any end organ failure.
  2. Tumor Lysis Syndrome results from high turnover of malignant cells resulting in severe metabolic derangements including hypocalcemia, hyperkalemia, hyperphosphatemia, hyperuricemia, AKI, metabolic acidosis. Be suspicious of this in patients presenting with edema, hematuria, fatigue, weakness, altered mental status or symptoms that go along with specific metabolic derangement, particularly if they recently received chemotherapy, radiation or high dose steroids.