Conference Notes:

Lightning Lectures:

– Priapism: 3 types Ischemic (emergent and most common), non ischemic (trauma/fistula/congenital), stuttering. Common causes: adult medications, children SCD. Dx with PE/blood aspiration/US. Tx: phenylephrine/aspiration.

– Epididymitis: Causes are mostly STI organisms and E. coli. Acute less than 6 weeks. Orchitis: usually with epididymitis. Dx: US to rule-out torsion if suspected, gram stain, MB, GV, UA. TX: Ceftriaxone, Doxy if enteric organisms suspected Ceftriaxone and Levofloxacin. Can be associated with nec fasc. Chronic greater than 6 weeks: most common cause TB will need urology consult.

Dr. Eisenstat Lecture:

– Med Safety: PD vs PK – ADME absorption (bioavailability: IV is 100%, not affected by age, mostly by route and other drugs/diseases), distribution (volume of distribution less than 1 = more in serum, elderly have less water and more fat and less albumin which increases volume of distribution and free drug respectively), metabolism (enzymes), elimination (liver vs renal). T1/2: half life, time which is required to for initial concentration to decrease by 0.5 (changed by metabolism or elimination). Elderly high risk for adversed drug events ADE. Beers List: opioids, SSRI, TCA, anti-cholinergics, anticoags, benzos, anti-pysch, others.

Dr. Price Lecture:

– Is that your final Answer?: paramedics are trained in determining death on scene.

– Urolithiasis: Imaging: CT vs US: looking for hydronephrosis or hydroureter on US, non-con CT most sens and spec for stones. Who to image: no hx of stones, older age, complications (fever, infection on UA, transplanted kidney/solitary kidney, AKI), Management: pain ctr, labs, imaging, medical expulsion therapy. Look for other causes of symptoms.

Cystitis and Pyelonephritis:

– Cystitis: signs and symptoms: hematuria, CVA, back pain, freq, dysuria (in males think prostatitis). Urine dipstick: nitrites very spec not sens, leukocyte esterase most sens not spec, for a dipstick test when both are negative post-test prob at 5% . Asympto bacteriuria: no need to rx unless preg/urologic surgeries/transplant kidney.

– Pyelonephritis: UTI plus CVA/fevers/N/V – will need urine cultures drawn and antibx coverage. Most can be DC home unless unable to tolerate PO or septic

– Rx: uncomplicated: Macrobid, TMP-SMX, fosfomycin, cephalexin. Complicated: Cipro, Levo, TMP-SMX plus all these should get 1 dose of IV antibx (usually ceftriaxone)

Flow chart to be posted in Room9er