Tumor Lysis Syndrome – Dr. Aher

typically occurs within days after chemotherapy.

Findings of: Hyperkalemia, Hyperuricemia, Hyperphosphatemia, HYPOcalcemia (2/2 phosphate binding Calcium

Dialysis indications: Potassium >6, Cr. >10, Uric Acid >10, symptomatic hypocalcemia, Phos >10, Volume overload

Methemoglobinemia – Dr. Norby-Hill

Can happen with dapsone overdose

Dissociation between SPaO2 and PaO2

Acquired cases from medications and environment, commonly dapsone, local anesthetics, nitrites, h202

50% is fatal

Features: refractory to supplemental o2, color of blood, cyanosis, respiratory depression

Tx: methylene blue (Not in G6PD or those on SSRIs as MB is MAOI), ASCORBIC ACID, EXCHANGE TRANSFUSION

Pediatric Surgical Emergencies – Dr. Robin Lund

Early blood tinged emesis – cracked nipples

Pyloric stenosis: M>F 4:1, 3 to 5 weeks, veracious eaters, NBNB projectile every feed, dehydration, malnutrition

Appy’s usually missed the younger they are

Intuss – 6 mo to 3 yo; ddx Meckels and hsp. 

Features: colicky severe, 20 min, emesis, sausage mass

NEC: sudden feeding intolerance, distention, tenderness, bilious vomiting, diarrhea, rectal bleeding

Malrotation: <1* vomiting, sick, abd distension, peritonitis.

Heme emergencies – Dr. McGee

1 single unit of donor platelets raises plts by 30k

Transfusion indications: <10k (20k if febrile or septic), <50k active bleeding, <100k CNS bleeding or neuraxial surgery

-vwb dz tx for minor bleeding is ddavp

Post transfusion purpura: alloantigen on transfused plts: t penia, purport, clinically significant bleeding. Tx IVIG

Don’t forget about HIIT if recent inpatient stint

MAHAs – non immune HA.

TMAs: microvascular hemolysis; tap, has, drug, complement, pregnancy, htn emergency

High Sensitivity Troponin – Dr. Adam Ross

6 or above reported. Anything less than 20 nl in males; <15 normal in females

>88 MI

15 or greater (change in either direction) increase is clinically significant (2 hours)

TBD if there will be poc trop in R9

Single trop undetectable with >3 hours of symptoms

Hemophilia Lecture

A is Factor VIII deficiency

B is Factor IX

Both are 

VWD: VWf “chaperones” Factor VIII and facilitates its efficacy

Emicizumab: bispecific mab. Helps factor 9 and 10 work. Subcutaneous injection prophylactically.

Meds ending in -ate are for VIII deficiency.

Transfusion Reaction – Dr. Bayers

1. TRALI vs TACO
   1. TRALI more often febrile, more often low BP
   2. TACO very consistent with CHF exacerbation, likely preceding CHF.
2. Other Transfusion Reactions on the Differential
   1. Anaphylaxis
   2. Sepsis – Transfusion Transmitted
   3. Urticaria
   4. FNHTR
   5. AHTR – usually secondary to ABO incompatibility: send Coombs, recheck T&S, DIC, Haptoglobin

If Fever and no other symptoms: stop transfusion, give antipyretic, wait 30 minutes and continue transfusion

Research Overview – Dr. Huecker

Think Do Write

Be passionate

Research Louisville September

ACEP October

CORD March

AAEM April

SAEM May

IRB submission typically takes one month

Common IRB approved research:

-human subjects research

-quality improvement

-program evaluation

Utilize Jacob

-plan stats, charts, graphs, that you want back in a timely fashion. Give him time to complete

Tuberculosis – Dr. Matthew Keller

Most common symptom is cough

8 weeks for exposure testing

2-4 weeks of treatment of active TB before non-infectious

Active TB:

Symptomatic +ppd, +qfg, abnormal cxr, +sputum or culture -> RIPE

Latent TB Isoniazid x9 months

Don’t treat CAP with quinolone (especially) if TB is on ddx

Case Follow Up: Hyperviscosity syndrome – Dr. Slaven

Hyperviscosity syndrome

Features: fever, fatigue, headache, blurred vision, dyspnea, chest pain. polycythemia, thrombocytosis.

Mgt: Give IV fluids Consider phlebotomy.

Causes of fever other than obvious: Infection/Iatrogenic, Mets, AI, Drugs, Endocrine, Clots. (IMADEClots)

Case Follow Up: Febrile Neutropenia – Dr. Ferko

ANC <500 + fever

More than 80% hematologic malignancies. Often currently receiving chemo

Blunted immune response; not necessarily SIRS

COPD places into high risk category.

To be low risk category, everything needs to look good, including transportation and likelihood to follow up

Consider using MASCC Risk score

Admit: Cover pseudomonas, not necessary to start MRSA coverage unless:

Pneumonia

Not HDS

If MRSA suspected

Catheter or skin and soft tissue infection