December 2, 2020

Take Home Points
  • Be sure to consider mesenteric ischemia in any elderly patient with abdominal pain or lower gastrointestinal (GI) complaints.  Remember, the presentation can be tricky to find and they may have a reassuring abdominal exam.
  • Ask about artherosclerotic risk factors, history of cardiovascular disease including atrial fibrillation and prior embolic events, and a history of intestinal angina to help clue you in to the diagnosis.
  • Lab abnormalities could include leukocytosis, lactemia or elevated d-dimer.  But normal labs cannot exclude this disease.
  • The money is in the CTA.  Get it as fast as possible because time is bowel.
  • Consult your surgeons and interventional radiologists eary, because again TIME IS BOWEL

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 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)