Paucis Verbis: Influenza – To treat or not to treat?

SwineFlu-1It’s coming. Influenza season is almost upon us.

Influenza season typically peaks in the United States during the Jan-Feb months and can start as early as October. You can read about the 2011-12 seasonal flu data on the CDC website.

Should you give a patient with influenza an antiviral agent or just provide supportive therapy?

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2019-01-28T22:35:37-07:00

Trick of the Trade: Needlestick hotline 888-448-4911

NeedlstickGlove

You are a fourth-year medical student and super-excited to be doing your first supervised central line procedure on an actual patient. You have done so many central lines on mannequins and simulations. You feel ready. In your excitement, however, you stick yourself with the 22 gauge finder needle after you successfully get a flash-back of the patient’s venous blood.

After handing off the procedure to your senior resident, you go into a mild panic. Your patient is a known HIV patient with an unknown CD4 count and viral load. After taking off your gloves and washing your hands, you report this to the attending.

Should you start post-exposure prophylaxis medications for HIV? You remember that if post-exposure HIV medications are recommended, you should start it immediately and definitely within 2 hours of exposure.

It’s difficult to concentrate when faced with so many questions whirling in your mind.

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2019-01-28T22:38:19-07:00

Paucis Verbis: Does this DM leg ulcer have osteomyelitis?

DMfootulcerWe sometimes see diabetic patients in the ED for a worsening foot ulcer. Sometimes it’s the chief complaint. Other times, however, you just notice it on physical exam. So, be sure you examine the feet of your diabetic patients. Occasionally, you’ll be surprised by what you find.

Several questions come up with diabetic foot ulcers:

  • Is it a true diabetic foot ulcer, or is it an arterial or venous insufficiency ulcer?
  • Is there underlying osteomyelitis?
  • How can I best diagnostically work this foot ulcer up for osteomyelitis?
  • What is the Wagner grade of this ulcer? (I think it’d be Grade 2.)

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2017-08-01T23:30:55-07:00

Paucis Verbis: Spinal epidural abscess

afp20020401p1341-f2One of the most challenging diagnoses to make is that of a spinal epidural abscess (SEA), especially if you work in an Emergency Department which cares for many IV drug users and HIV patients. There’s never before been a published diagnostic guideline or algorithm which helps you with risk-stratification.

In the Journal of Neurosurgical Spine, a diagnostic guideline was prospectively evaluated on a small population (n=31) as compared to historical controls (n=55). They found that an ESR test had a sensitivity of 100% if a patient had at least 1 risk factor for SEA. A CRP test was much less helpful.
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2017-08-03T00:29:11-07:00

Trick of the Trade: Topical anesthetic cream for cutaneous abscess drainage in children

AbscessDiagramAbscess drainage can be painful and time consuming in the ED. Can this article help? 1

Trick of the Trade

Apply a topical anesthetic cream on skin abscesses prior to incision and drainage (I and D).

In this press-released article in American Journal of Emergency Medicine, the authors found that application of a topical 4% lidocaine cream (LMX 4) was associated with spontaneous cutaneous abscess drainage in children.

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2019-07-10T21:29:20-07:00