UCONN Emergency Medicine Interest Group

Posts Tagged ‘attendings’

Upcoming meeting

In ANNOUNCEMENTS on March 13, 2012 at 7:53 PM

The next EMIG meeting has been scheduled for Monday, March 26th from 6-8 PM at Dr. LaSala’s. Further details available by contacting lburns@up.uchc.edu. Presenters will be Drew Cathers, Tony Faustini, and Christian Kakowski.

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Upcoming meeting (tonight)

In ANNOUNCEMENTS on November 28, 2011 at 1:11 PM

The next EMIG meeting has been scheduled for Monday, November 28th from 6-8 PM at Dr. LaSala’s. Further details available by contacting lburns@up.uchc.edu.

Upcoming meeting

In ANNOUNCEMENTS on October 19, 2011 at 11:49 AM

The next EMIG meeting has been scheduled for Monday, October 24th from 6-8 PM at Dr. Smalley’s. Further details available by contacting lburns@up.uchc.edu. Presenters will be Colin Huguenel, MSIV and Dr. LaSala.

Pearl/Pitfall: Cyanide

In PEARL/PITFALL on October 2, 2011 at 8:00 AM

Based on discussion/lecture from Dr. O`Toole, Emergency Physician and Medical Toxicologist at Hartford Hospital:

In the case of a patient presenting with new onset seizures, tachycardia and hypotension with elevated lactate and acidosis, always consider cyanide poisoning as a potential etiology.

In brief, a lethal dose to adults of potassium cyanide is ~200 mg. Cyanide inhibits many enzymes, perhaps most importantly cytochrome oxidase at cytochrome a3 in the electron transport chain, inducing cellular asphyxia by preventing aerobic metabolism. This results in movement towards anaerobic metabolism, ultimately producing lactic acidosis.

Cyanide is also a neurotoxin by several mechanisms, including impairment of metabolism as above, as well as increased release of excitatory neurotransmiters and increasing/activation of NMDA receptor activity, producing a number of CNS s/s including seizures.

It should be noted that cyanide does cause variable cardiovascular effects depending on when in the course of the exposure the patient is observed. Initially, cyanide causes bradycardia and hypertension, followed by hypotension and reflex tachycardia, and finally, bradycardia and hypotension leading to death.

As there is now a very safe antidote, hydroxocobalamin available, which essentially binds cyanide to become cyanocobalamin (ie. vitamin B12), early recognition of this poisoning may be life-saving.

Reference:

Hoffman, Robert. Goldfrank’s Manual of Toxicologic Emergencies. New York: McGraw-Hill, 2007.

Upcoming meeting

In ANNOUNCEMENTS on September 21, 2011 at 7:01 PM

The next EMIG meeting has been scheduled for Monday, September 26th from 6-8 PM at Dr. Fuller’s. Further details available by contacting lburns@up.uchc.edu. Presenters will be Colin Huguenel, MSIV and Max Falkoff, MSIV.

Off Service #2: Heme/Onc

In OFF SERVICE on August 26, 2011 at 7:00 AM

Dr. Gilcrease, Heme/Onc Fellow, University of Utah/Huntsman Cancer Institute

Approach towards neutropenic fever

1. Identify using definitions:

  • ANC < 500 (or will be <500 in 48 hrs, but this is difficult for EPs to determine). Profound neutropenia is ANC < 100.¬†Note: this count includes neutrophils and bands (but not more immature cells).
  • Fever = any T>38.3 (101 F), or T>38 (100.4) for >1 hr.¬†Note: the elderly and pts on corticosteroids may not mount a fever! Also,¬†remember that not all fever = infection.

2. Risk stratify

  • Hisk risk by IDSA 2010 criteria: ANC<100 for >7 days, comorbidities (including GI sx, neuro sx, central venous catheter infection, etc.), hepatic injury (transaminases >5x upper limit of normal), renal insufficiency (CrCl<30)
  • Alternative risk stratification is the MASCC score, but this is more complicated; if used, score >=21 is high risk.
  • If high risk, hospitalize and give IV abx.
3. Initial management
  • Exam- be thorough, do not forget skin, mucosal, port-a-cath, central lines, wounds, abdominal exam. Remember that neutropenic pts frequently will not show signs of infection (eg. abscess, induration, warmth, pulmonary infiltrate). DO NOT do a rectal exam (may cause a bacteremia).
  • Labs- CBC, CMP, UA, directed imaging, blood cx from central venous catheter if present and 2 peripheral sites, directed tests as needed (eg. LP, wound cx, CDiff toxin, stool cx).
  • Abx: within 2 hrs of presentation.
    • Outpatient: cipro/augmentin or levofloxacin
    • Inpatient: meropenem +/- vancomycin
      • If any mucosal breakdown, skin breakdown, concern for central-line infection, pneumonia, give a dose of vanco.

Upcoming meeting

In ANNOUNCEMENTS on August 26, 2011 at 1:44 AM

The next EMIG meeting has been scheduled for Monday, August 29th from 6-8 PM at Dr. Regan’s. Further details available by contacting lburns@up.uchc.edu. Presenters will be Katherine Farmer, MSIV and Colin Huguenel, MSIV.

 

Upcoming meeting

In ANNOUNCEMENTS on June 24, 2011 at 3:08 PM

The next EMIG meeting has been scheduled for Monday, June 27th at 6 PM at Dr. Regan’s. Further details available by contacting lburns@up.uchc.edu.

Off Service #1: OB/GYN

In OFF SERVICE on April 18, 2011 at 8:02 PM

This is the first entry in what will be a recurring series. Seasoned attendings from specialties outside EM will be asked the following question: “What clinical advice would you give students going into Emergency Medicine regarding an acute issue in your field?”

Dr. Larhmann, OB/GYN, Hartford Hospital:

1. Order type and Rh on pregnant women that come into the ED with a complaint of bleeding, and give Rhogam if appropriate. Rhogam needs to be given within 72 hours to be effective.

2. Consider the diagnosis of preeclampsia if a pregnant woman comes in with headache and visual changes- order a UA and LFTs!

3. Don’t rely on serum B-hCG level for figuring out gestational age; remember that it has a bell-shaped curve.

Upcoming meeting

In ANNOUNCEMENTS on April 18, 2011 at 5:39 PM

The next EMIG meeting has been scheduled for Monday, April 25th at 6 PM. Further details available by contacting lburns@up.uchc.edu.

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