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Paucis Verbis: Pneumonia risk stratification tools

Pneumonia RUL CXR

Pneumonia is a common cause for ED visits. How do you decide on whether the patient can be managed as an outpatient or inpatient? To supplement your clinical judgment, many clinicians use the Pneumonia Severity Index (PSI) score.

Have you heard of CURB-65, supported by the British Thoracic Society? What about SMART-COP, which is meant to help you predict if your patient will need Intensive Respiratory or Vasopressor Support (IRVS)?

PV Card: Risk Stratification Scoring Tools in Pneumonia


Go to the ALiEM Cards for more resources.

By |2021-10-16T19:31:04-07:00Feb 25, 2011|ALiEM Cards, Pulmonary|
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Paucis Verbis card: Pertussis

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?

You won’t like the answer. It often presents like the common cold and clinical symptoms are minimally helpful in making the diagnosis. So, according to the American Academy of Pediatrics, you should treat anyone under the age of 3 months in whom you suspect pertussis. Complications from pertussis in infants include apnea, seizures, secondary pneumonia, and death. That means any with an innocent cough should be treated with azithromycin!

The following is a meta-analysis article from JAMA on diagnosing pertussis in adolescents and adults.

PV Card: Pertussis


Adapted from [1]
Go to ALiEM (PV) Cards for more resources.

Reference

  1. Cornia P, Hersh A, Lipsky B, Newman T, Gonzales R. Does this coughing adolescent or adult patient have pertussis? JAMA. 2010;304(8):890-896. [PubMed]
By |2021-10-18T10:07:39-07:00Sep 3, 2010|ALiEM Cards, Infectious Disease, Pulmonary|
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Paucis Verbis card: ABG interpretation

ABG interpretationI have yet to find a better arterial blood gas interpretation review article than the 1991 Western Journal of Medicine summary by Dr. Rick Haber.

This installment of the Paucis Verbis (In a Few Words) e-card series reviews ABG Interpretation. The recent addition of an ABG machine in our ED has made a tremendous difference in our ability to care for undifferentiated patients. This is a refresher in making heads and tails of mixed acid-base disorders.


Adapted from [1]
Go to ALiEM (PV) Cards for more resources.

Reference

  1. Haber R. A practical approach to acid-base disorders. West J Med. 1991;155(2):146-151. [PubMed]
By |2021-10-19T18:53:19-07:00Apr 2, 2010|ALiEM Cards, Endocrine-Metabolic, Pulmonary|
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