Journal Club – Dr. Mary Jane Schumacher

-Compression therapy for prevention of recurrent cellulitis of the leg – do it

-TXA vs oxymetazoline for hemostasis in epistaxis: need a better study, would still try Affrin first but remember TXA as another option as this review shows it could be clinically beneficial and may prevent need for nasal packing

72 hour returns/Deaths in ED/Deaths within 24 hours – Dr. Mary Jane Schumacher

-Great job on care of patients and documentation

–For documentation: remember to take out the things that are saved in every note but do not apply. For ex. a patient dies in the ED, do not have in your note: discussed plan and all of their questions were answered or follow up with primary care physician upon discharge

-Important patient care points:

Remember to think of social situation and set patients up for success if going to discharge. Are they going to go home and fall and break a hip/get a brain bleed? Do they have a PCP to follow up with?

If vitals or clinical change on a trauma patient – repeat FAST.

Seizure patients – monitor in ED for a period of time, give their seizure meds/keppra load if they have definitely missed doses and discharging but be cautious of restarting Lamotrigine for risk of SJS if they haven’t been taking it. People coming back with recurrent seizures – neuro consult.

Alcohol withdrawal – really pay attention to these people, they can become sick very quickly. Symptoms can range from mild to severe. Recognize the symptoms from tremors/tachycardia to hallucinations/delusions and seizures. If alcoholic and reported seizure at home and don’t look well, consider admission. If they look well, can give phenobarbital 260 IM if discharging as it has a long half life and can prevent decompensation. You can also give phenobarbital IV if admitting for sxs.

Cirrhotics – use ideal body weight, use LR for resuscitation. Don’t forget considerations of Albumin in SBP, HRS, etc.

Morbidity and Mortality Case – Dr. Caleb Webb

-HIV/AIDS: AIDS when CD4 count <200

-AIDS defining illnesses: Several; discussed cryptococcosis, MAC, PCP

-Cryptococcal Meningitis: HA, fever, neck pain, n/v, photophobia. Will see increased ICP on lumbar puncture. Need to specifically order crypto testing on CSF fluids. Treatment is induction therapy with Amphotericin B and Flucytosine.

-MAC: most likely when CD4 count <50. Disseminated MAC: fever, night sweats, abd pain, diarrhea, weight loss. Diagnosis via isolation of MAC from the blood.

-PCP: diffuse, bilateral interstitial infiltrates. Induced sputum sample. Consider ordering LDH as often elevated.