UCONN Emergency Medicine Interest Group

Posts Tagged ‘infectious diseases’

EM Images #9

In IMAGES on December 4, 2011 at 7:00 AM

Syndicated from the UCONN EM Residency website; credit to Dr. Suozzi for images and text.

Just a short hint for this case: this is from a patient that Dr. Suozzi saw in Uganda.

What is the diagnosis?

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EM Images #7

In IMAGES on September 12, 2011 at 3:46 PM

Syndicated from the UCONN EM Residency website; credit to Dr. London for images and text.

Scenario: a 47-year-old gentleman came for a follow-up visit for positive blood cultures. He had been seen 2 days earlier with a past medical history of asthma and the history that approximately two weeks earlier he had been at a campfire where apparently someone nearby was burning poison ivy. Immediately he had broken out in a rash on his hands and neck and face and all areas that were exposed and not covered by clothes. He also noticed that his symptoms of cough and shortness of breath increased after that incident. He then came to HHED where he had had blood cultures, an x-ray that showed pneumonia and had been discharged on azithromycin. His blood cultures were positive for Staph and he had been requested to return to the ED. His physical exam showed some inspiratory râles in the LLL where the infiltrate had been and some expiratory wheezes throughout. After treatment had been initiated in the ED, prior to admission, he developed another skin eruption, seen in accompanying photograph.

What was the treatment and what is this reaction? (click below to see answers below the fold)

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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.

EM Images #3

In IMAGES on June 10, 2011 at 9:34 PM

Syndicated from the UCONN EM Residency website; credit to Dr. London for images and text.

This is a case of a 13 year old otherwise healthy female who presents to the ED with a rapidly progressive rash over the past 2 days which initially started on her trunk and then spread to her extremities. There is no face, neck or mucosal involvement. The rash is pustular rather than vesicular and is follicular in distribution. This came on several days after going in a hot tub which was newly opened for the season. She is fully vaccinated for varicella.

What is the first-line treatment for this disease?

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