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29 10, 2010

Paucis Verbis card: Algorithm for suspected pertussis in pediatrics

2019-01-28T23:21:12+00:00

ChildCough

To treat for pertussis or not?

In the setting of the current pertussis epidemic in California, each kid with a cough sparks constant debate about whether to treat with azithromycin or not. Finally, thanks to my friends Dr. Andi Marmor and Dr. Shon Agarwal Jain (UCSF Pediatrics faculty), there’s a great algorithm to help you answer the question. I have found this algorithm extremely helpful.

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3 09, 2010

Paucis Verbis card: Pertussis

2019-01-28T23:23:30+00:00

Pertussis Organism

Is your Emergency Department administering Tdap immunization boosters instead of dT boosters? Patients with wounds are getting updated not only for tetanus and diphtheria, but also now for pertussis.

Apparently there has been sharp rise in the national incidence of pertussis (Bordetella pertussis shown in image) in 2010. The infection has been documented in both infants (underimmunized less than 3 months old) and adolescents/adults (loss of immunity after 10 years). In fact, the CDC has issued an epidemic warning in California.

How do you diagnose pertussis ? What are the classic symptoms? Better yet, how do you rule-it out clinically?

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20 08, 2010

Paucis Verbis card: Croup

2019-01-28T23:25:57+00:00

The most common cause of stridor in pediatric patients is croup, or laryngotracheobronchitis. The distinct high-pitched, seal-like,”barky” cough can be heard from outside the patient’s room often.

Check out the clip above that I randomly found on YouTube. Go to the 1:15 mark (near the end) to hear the barking cough. Poor but cute kid.

What is the current treatment regimen? Did you know that the traditional treatment with cool mist or humidified air have shown to be of no added benefit?

PV Card: Croup


Go to the ALiEM Cards site for more resources.

11 06, 2010

Paucis Verbis card: Septic Arthritis

2019-01-28T23:40:11+00:00

Knee PainIn the workup of monoarticular arthritis, the question that emergency physicians constantly struggle over is whether the patient has a nongonococcal septic arthritis. This joint infection alarmingly damages and erodes cartilage within only a few days.

This installment of the Paucis Verbis (In a Few Words) e-card series reviews the JAMA Rational Clinical Examination article which asks “Does this patient have septic arthritis?” Pooled sensitivities and likelihood ratios were calculated. These statistics are always helpful when trying to figure out the patients probability of having a septic joint.

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16 04, 2010

Paucis Verbis card: Early goal directed therapy

2019-01-28T23:42:48+00:00

Cells3dsmOne of the landmark studies in sepsis was conducted by Dr. Emanuel Rivers (Henry Ford) and published in the New England Journal of Medicine in 2001. By managing patients with severe sepsis and septic shock with an “early goal directed therapy” approach, there was an absolute risk reduction of 16%. Furthermore, the number needed to treat to save a life was 6 patients!

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29 12, 2009

Paucis Verbis Card: CNS Infections

2019-01-28T23:52:20+00:00

PV Card: CNS Infections

Here is another installment of the Paucis Verbis (In a Few Words) e-card series on the topic of CNS infections from EM Clinics of North America 2009.

 


Adapted from 1
Go to the ALiEM Cards site for more resources.

1.
Somand D, Meurer W. Central nervous system infections. Emerg Med Clin North Am. 2009;27(1):89-100, ix. [PubMed]