September 16, 2020

Take Home Points

  • Wernicke encephalopathy is characterized by ataxia, altered mental status and ophthalmoplegia but patients are unlikely to have all these components
  • Suspect Wernicke encephalopathy in any patient that is at risk of malnutrition or malabsorption and has any one of the classic symptoms
  • Prophylactic administration of thiamine 100 mg IV/IM to at risk patients can prevent development of the disease
  • Once Wernicke encephalopathy has developed, it must be treated with high-dose, IV thiamine

September 7, 2020

Definition: Medial or posterior slippage of the femoral capital epiphysis relative to the metaphysis

Epidemiology:

  • Classic patient group: overweight adolescent boys
    • Over 80% of SCFE involves children with a BMI > 95th percentile (Manoff 2005).
    • Average age of onset: 12 years old
  • Bilateral SCFE is fairly common
    • 23% will have contralateral disease at the time of initial presentation, despite only complaining of unilateral pain (Hagglund 1988, Loder 1993).
    • Up to 60% of patients will go on to develop bilateral SCFE in their lifetime
    • 88% of subsequent slips occur within 18 months of diagnosing the first slip
  • Influenced by bone maturation, strength, and weight mismatch.
  • SCFE has also been associated with endocrine disorders such as hypothyroidism, hypogonadism, pan-hypopituitarism, but this is not as common.

September 2, 2020

Take Home Points
  • Focus on resuscitating well by focusing on the basics
  • Recognize Massive GIB (MGIB) with a thorough exam of the patient and vital signs (Shock index >0.7 is ABNORMAL and signals impending shock)
  • Obtain large bore PIV access and prioritize transfusion over crystalloids for MGIB
  • Get consultants on board early
  • Give adjunctive medications that impact mortality (ie A 3rd generation cephalosporin in patients with variceal bleeding or a history of cirrhosis)

July 22, 2020

Take Home Points
  • Spinal Epidural Abscess may present insidiously and patients often lack the classic triad of fever, back pain and neurologic symptoms
  • Empiric Antibiotics should cover Staphylococcus (including MRSA) and Gram negative Bacilli
  • All patients with clinical suspicion require rapid evaluation with MRI as the diagnostic study of choice
  • Although not all patients will go to the operating room, surgical consult (Neurosurgery or Orthopedics) should be obtained emergently