Contributor: Ricky Dhaliwal, MD Educational Pearls: Primarily affects children <6 years old and adults with kidney disease Caused by staph aureus releasing exotoxins that result in erythema and sloughing of the skin Present with significant pain, dehydration and underlying staph infection Treatment typically oxacillin/nafcillin with admission for wound care with petroleum gel and xeroform Burn…
Read MoreContributor: Ricky Dhaliwal, MD Educational Pearls: Rhabdomyolysis occurs when high levels of myoglobin are released from dying muscle tissue into the blood Severe levels of myoglobin cause renal injury Causes include elevated temperature, excessive exercise, toxins, infection, muscle ischemia, crush injury, and prolonged immobilization Can also be caused by medications, like antipsychotics, statins, SSRIs, colchicine,…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: Study in NEJM looked at occult hypoxemia, when oxygen saturation reads at >92% when the actual saturation is <88% Rate of occult hypoxemia was 3 times higher in those who identified as black (12% vs 4%) Keep this disparity in mind when providing care to patients of all backgrounds…
Read MoreContributor: Peter Bakes, MD Educational Pearls: Febrile Seizure clinical criteria 6 months – 5 years of age Rapid rise in temp No preexisting seizure disorder No other explanation for the seizure Nonfocal seizure lasting less than 15 minutes If the seizure does not meet the above criteria, a full workup needs to be completed Regardless…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: Acid and alkali ingestions have differing prognosis and immediate concerns Immediate issues can include superficial irritation, severe burns, esophageal perforation, and even airway compromise from edema Long term morbidity can include strictures Supportive care is typically all that can be provided in the emergency department Diagnostics may include imaging…
Read MoreContributor: Peter Bakes, MD Educational Pearls: Lyme disease gives a single expanding target lesion with central clearing called erythema chronicum migrans Erythema multiforme is another targetoid rash that presents with multiple target lesions Characterized into erythema minor and major based on severity but typically resolves More severe hypersensitivity reactions include Stevens-Johnson Syndrome (<10% skin involvement),…
Read MoreContributor: Adam Barkin, MD Educational Pearls: Fever is an adaptive response to infection, but elderly and immunocompromised patients may not be able to mount a hyperthermic response in sepsis Patients with fever in sepsis end up receiving treatment earlier and have better outcomes Hypothermic patients with severe sepsis admitted to the ICU had a 32%…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: Survey study compared depression symptom prevalence in the United States at the beginning of COVID compared to data acquired by a similar survey for 2017-2018 and found it was three-fold higher Mild symptoms: 25% during pandemic; 16% before Moderate: 15% during pandemic; 6% before Moderately Severe symptoms: 8% during…
Read MoreContributor: Ricky Dhaliwal, MD, JD Educational Pearls: Glucagon administered intravenously has a high rate of adverse events (nausea/vomiting) with very weak evidence NItroglycerin too has very limited evidence but a much better adverse event profile Mix 0.4 mg (1 sublingual tablet) nitro in 10 mL of water and administer orally Nothing beats upper endoscopy for…
Read MoreContributor: Jared Scott, MD Educational Pearls: While it is rare to have a native hip dislocation, it is relatively common to dislocate a prosthetic hip The mechanism for dislocation is usually adduction, flexion, and internal rotation the hip which can occur when walking Arthroplasty in the setting of trauma or fracture, posterior approach during surgery,…
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