Dr. Leasau- DRESS

• Morbilliform rash >50% of skin, facial swelling and edema, fever 
• Negative nikolsky sign
• 2-6 wk after new drug
• Common drugs: phenytoin, phenobarb, carbamazepine, allopurinol, sulfa drugs
• Treatment: discontinue offending drug, supportive care, +/- corticosteroids

Dr. Drury- abscesses

• Erythematous nodules, forming pus filled cavity anywhere on the body

• Mostly MRSA, some MSSA but can be any skin flora or fungi
• Consider consulting: perirectal, involvement of tendon sheaths, large size, pulsatile mass
• POCUS
  • Abscess- pocket of localized anechoic fluid
  • Cellulitis- cobblestoning
• Treatment: I&D, most will require antibiotics unless simple/single abscess and low risk

Dr. Shoff- patient experience

• When you triage a patient from room 9,  let the patient know what is happening before you roll them out
• Tell patient the buzzer means a trauma or a stroke that is an emergency, will be right back as soon as you are done
• Recap room 9 findings and tell patient what next steps are before you send the patient to CT
• Tell patient plan for the visit prior to leaving the room when you first see them
• Ask the patient what they are concerned about, tell them how you are going to address that concern

Dr. Klaszky- Invasive Mechanical Ventilation in the ED

• Starting settings: PEEP 5, TV 6ml/kg IBW, RR 16-18
• Modes of ventilation:
  • AC: full support, set RR, if patient breathes over that rate- ventilator takes over
  • SIMV: moderate support, set RR, if patient breathes over that rate- patient does the work of breathing
  • PS: minimal support, no set RR, patient does most of the work of breathing
• VC: set tidal volume, monitor pressure (peak/plateau) 
• PC: set pressure, monitor tidal volumes
• Combining AC with VC or PC
• Targeting sat with FiO2 is 88-95%
• ARDS- PEEP responsive
• Plateau pressure- want to keep less than 30 to avoid injury to the lung
  • Tidal volume and PEEP affect plateau pressure, can decrease one or the other if need to get plateau pressure below 30
  • If you have to drop tidal volume, will need to increase RR to get same minute ventilation, often have to increase to mid/upper 20s, low 30s 
• Alveolar ventilation = TV – dead space

Dr. Hudson/Dr. Blair- airway procedure sim

• LMA: supraglottic tube + mask with inflatable cuff that sits above vocal cords
• NPA: uncuffed tube inserted via nose that sits in posterior oropharynx
• OPA: rigid, inserted into the mouth resting behind the tongue to prevent tongue obstruction of airway
• Cricothyroidotomy: can’t intubate, can’t oxygenate