Conference notes 10/2/2024

  • Lightning lectures Dr. Gosser, Dr. Angel, and Dr. Gronemeyer
    • Oral Abscesses
      • PTA       
        • uvula deviation, pain, fever, sore throat, trismus, muffled voice
        • CT w/ contrast
        • Strep/staph, anaerobes
        • I&D, clindamycin or augmentin outpatient, Unasyn inpatient
    • Dental abscess
      • Pain, tooth elevation, tenderness and swelling around tooth
      • CT if concerned for deeper abscess
      • Nsaids, opioids or local anesthetics, Dental follow up within 48 hrs, can do I&D
      • Augmentin, clindamycin, or Unasyn
    • Dacrocystitis
      • Infection of lacrimal sac due to blocked lacrimal duct
      • Swelling erythema and edema between medial canthus and nasal bridge
      • Manage with PO clindamycin, warm compresses, decongestants
    • Hordeolum (stye)
      • Blockage and infection of sebaceous/sweat glands of eye
      • Pustule with pain on eyelid
      • Treat with warm compresses
    • Blepharitis
      • Bacterial infection of meibomian gland
      • Swelling and erythema with pain and itching
      • Treat with hygiene, warm compresses, can use topical bacitracin
    • Prespetal and orbital cellulitis
      • Fever, Eyelid swelling and erythema with both
      • Orbital cellulitis will have visual defects, proptosis, and pain with EOM
      • Preseptal cellulitis is usually staph/strep, treat with Bactrim AND amoxicillin (or cefpodoxime or cefdinir)
      • Admit orbital cellulitis, treat with vanc/Unasyn (or vanc/zosyn), add ampho B for fungal infections if dm or immunocompromised
    • Herpes zoster ophthalmicus
      • Fever, headache, Hutchinson sign (vesicles on tip of nose)
      • Slit lamp
      • Artificial tears, topical abx to prevent secondary infection, antiviral
    • Gonorrheal conjunctivitis vs chlamydial conjunctivitis
      • 3-5 days post partum for gonorrheal, 5-12 days is chlamydial
      • Topical erythromycin
      • Adults treated with azithro/ceftriaxone
    • Temperomandibular disorder (TMJ)
      • Pain for 3+ months in TMJ
      • Managed with Nsaids, can use muscle relaxers, soft food diet
      • f/u with dentistry
    • mandibular dislocation
      • typically anterior, typically atraumatic
      • clinical diagnosis
      • CT face / IAC/temp bone if concerned for posterior dislocation especially if traumatic
      • Evaluate cranial nerves
      • Reduce by translating inferiorly and posteriorly
      • Can try syringe technique (97% success)
      • Discharge if uncomplicated otherwise
  • Dr. Aiello and Dr. Kushner
    • Septal hematoma
      • Clinical diagnosis. Collection of blood will lead to infection, septal perforation, saddle nose deformity.
      • Use 4% lidocaine cotton balls (can use oxymetazolone) and plug both nares for 5-10 min
      • Incise vertically, stagger incision if bilateral
      • Pack with sponge/tampon
      • d/c with abx and analgesics, f/u with ENT in 2 days
    • Auricular Hematoma
      • Can lead to chronic ear deformity if not expressed/drained
      • Auricular block
      • Superficial incision
      • Pressure bandage to prevent reaccumulating
  • Trachs, with Dr. Perling and Dr. Marks
    • Tracheostomy done for upper airway obstructions, or patients on prolonged mechanical ventilation.
    • 3-7 days for severe closed head injuries
    • Respiratory distress pathways and bleeding trachs
      • Most commonly trach fracture, displacement, obstruction, stenosis
      • Give O2 to stoma and mouth, remove inner canula, suction/confirm airway, confirm if trach patent or not. Bougie and re-trach, prepare to intubate from above
      • Tracheal infections = surgical consultation
      • Bleeding trach should raise concern, especially within 6 weeks
      • Beware sentinel bleeds
      • If bleeding; CUFFED tracheostomy
      • Manual compression if this fails.
      • CTA neck/chest
  • Buprenoprhine with Dr. Eisenstat
    • X waiver -> now MATE
    • Methadone and other maintenance therapies reduce overdose, comorbidities of OUD
    • It is meant to be bridging, not long term alternative
    • Methadone = full agonist, long acting, but must go get it daily. Also QT prolonging  
    • Bazett formula for QTc : QT/ (sqrt of) RR interval
    • Buprenorphine = extremely competitive agonist, can precipitate withdrawal
    • Suboxone = buprenorphine with naloxone (to prevent abuse)

2 thoughts on “Conference notes 10/2/2024

  1. Such a helpful article, thanks for posting! I can’t wait to implement some of these ideas. Fantastic job covering this topic in such depth! Fantastic job covering this topic in such depth! This post is really informative and provides great insights! Thanks for taking the time to put this together! Your writing style makes this topic very engaging. Great read! Looking forward to more posts like this.

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