ACEP Advocacy from Dr. Cirillo

-Projected EM physician may have a job shortage of up to 9500 jobs by 2030
-Medicare data used to compile this projections
-Concern may be that we need to further specialized into things like substance abuse specialist, emergency psychiatric specialist, observation unit specialist.
-ACEP wants to protect jobs
-ACEP supports mental health for ER physicians
-support silence on ED violence in conjunction with the ENA

-Message overall: get involved if you want meaningful change/advocacy for our specialty

Tropical Diseases with Dr. Heppner

Dengue Fever

-AKA breakbone fever, that leads to myalgia and arthralgia. Labs leukopenia, transmitted be a mosquito, endemic to Southeast Asia in South America. Treatment is supportive care. Transfuse as needed. Diagnosed clinically.

Yellow Fever

-most notable symptoms lately have dysfunction with associated jaundice. The remainder are nonspecific symptoms. Trended to be mosquito. Endemic intensely here in Africa, treatment is supportive care.

West Nile Virus

-Transmitted via mosquito should perform an LP, symptoms are usually asymptomatic and most patients, but can include nonspecific in such as fever headache myalgias lymphadenopathy. Endemic in the Middle East Africa Southeast Asia, diagnosis clinical, can order a special CSF test which is an IV GM antibody. Treatment is supportive

Pharmacy ID Review with Dr. Senn

You should treat asymptomatic bacteriuria in pregnant patients, patients that have had a renal transplant within the last month, and patient is going for GU surgery in the next 72 hours.
Epididymitis if concern for E. coli should be treated with levofloxacin. In patients less than 30 consider STI coverage in these patients.
Meningitis/encephalitis: Patient is greater than 65 should have ampicillin added on for Listeria coverage, in addition she was treated with ceftriaxone and vancomycin. When covering for Pseudomonas picture you on cefepime. If concern for fungal encephalitis include amphotericin B plus flucytosine.
C. difficile: Treat with vancomycin p.o. that is first-line. IV vancomycin does not cross over into the gut.
Fournier’s gangrene make sure you could broad-spectrum antibiotic coverage with the addition of clindamycin for toxin neutralization.
Tick bite: Prophylax patient’s if a tick was document for greater than 36 hours and within 72 hours of it being removed. Doxycycline should be used.
Post-exposure prophylaxis for rabies bites if the patient has been previously vaccinated they receive the rabies vaccine on day 0 and 3 after the bite. If they have no prior rabies vaccine they get a rabies vaccine on day 0 3/7/14 after the bite.
Febrile neutropenia: Defined as ANC less than 500. Should have broad-spectrum antibiotic coverage. With the addition of vancomycin. No vancomycin as needed for suspected UTI.

ID Lightning Lectures with Drs. Royalty, Strohmaier, and Jordan

Flu: URI symptoms fevers and myalgias. Usually self-limited disease. Those extremities age are at high risk. In addition people with significant comorbidities pregnancy or BMI greater than 40 or high risk. High mortality associated with a secondary bacterial pneumonia. Treatment is supportive and Tamiflu. Tamiflu carry significant risk with it including nausea vomiting psychiatric issues including hallucinations and suicide attempts. Consider starting Tamiflu if patient has been admitted. For those that are low risk used shared decision-making with the patient explained risks and benefits.

TB:
Primary usually asymptomatic, unless immunocompromise then may have B symptoms. Reactivation TB can include pulmonary plus systemic symptoms. May have extrapulmonary findings including pericarditis peritonitis encephalitis or meningitis and right adrenal insufficiency. Latent TB can include nodular findings on chest x-ray, complex. Miliary TB has a high mortality rate. Small nodes found on chest x-ray. But can occur anywhere in the body. Treatment is right therapy rifampin isoniazid pyrazinamide and ethambutol. For treatment of latent TB can treat with rifampin or isoniazid plus B6 dependent on liver enzymes. Rifampin preferred in people with liver dysfunction.

Syphilis
Sexually transmitted. Can be spread to other organs if left untreated. Primary syphilis is painless chancre that developed with 30 to 90 days after exposure usually currently on mucosal membranes. Not noticed on limited the genitals. Secondary syphilis, lymphadenopathy rash on the palms and soles. Tertiary syphilis can have cardiovascular findings included a dilated aortic root, aortic valve dysfunction, thromboses or clot formation within coronary arteries, neurosyphilis or, syphilis.
Neurosyphilis is a poor prognostic indicator. Can have ocular symptoms meningitis or seizures. Late findings of neurosyphilis or paresis psychosis tabes dorsalis ataxia pain bladder dysfunction dementia death. Syphilis does cross the placenta, as such congenital syphilis can occur.
Testing VDRL RPR.
Treatment was with penicillin 2,400,000 units pen GIM. For length and latent syphilis should be treated with a 2,400,000 units pen G IM . All neurosyphilis patient should be admitted for IV penicillin G.