Tag Archives: SakibMotalib

Keep it Cool with Frostbite

This week – the return of the King.  Sakib himself shares some information on appropriate care for frostbite injuries

Play it cool with frostbite

Quickhit:

–       Risk of cold injuries such as frostbite correlated with temperature, windchill, moisture

  • Risk is <5% when ambient temp (including wind chill) is >5 F (-15C)
  • Most often occur at ambient temp < -4 F (-20C)

–       Pathophys = freezing alone not sufficient to cause tissue death, Thawing contributing to endothelial damage is cause of majority of damage (see continue reading below)

–       Zone of injury = Zone of Coagulation, Zone of Hyperemia, Zone of Stasis

–       Treatment = Rapid re-warming with warm water. Do not debride any tissue initially.

–       Complications

  • 65% pt. experience sequeulae from their injuries
  • Hypersensitivity to cold, pain, ongoing numbness
  • Asthritis, bone deformities, dystrophia

Read below to get more thorough treatment maneuvers and further info on Frostbite Injury!

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IT’S THAT TIME OF YEAR: FLU QUICKHITS (PART 2)

Part two will cover the important basics about the flu treatment, chemoprophylaxis, high risk patient population w/ the flu management. This is a compilation of information provided by the CDC along with reference papers that have been clinically relevant as they have been referenced multiple times over the last few weeks during my rotation in the ED. 

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Note that Tamiflu is now FDA approved for patients age 2-weeks and older (FDA NEWS RELEASE link)

 

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Pregnant women

Oseltamivir is preferred for treatment of pregnant women. Pregnant women are recommended to receive the same antiviral dosing as nonpregnant persons

  • Zanamivir might be preferred by some providers because of its limited systemic absorption; however, respiratory complications that might be associated with zanamivir because of its inhaled route of administration need to be considered, especially in women at risk for respiratory problems
  • Pregnant women are known to be at higher risk for complications from infection with seasonal influenza viruses and severe disease among pregnant women was reported during past pandemics
  • Oseltamivir, zanamivir, rimantadine, and amantadine are “Pregnancy Category C” medications, indicating that data from clinical studies are not adequate to assess the safety of these medications for pregnant women

Persons w/ impaired renal function

Oseltamivir: For patients with creatinine clearance of 10–30 mL per minute, a reduction of the treatment dosage of oseltamivir to 75 mg once daily and in the chemoprophylaxis dosage to 75 mg every other day is recommended

  • Serum concentrations of oseltamivir carboxylate, the active metabolite of oseltamivir, increase with declining renal function.

Person w/ Immunosuppression

  • oseltamivir was safe and well tolerated when used during the control of an influenza outbreak among hematopoietic stem cell transplant recipients living in a residential facility
  • Source: (retrospective study: Vu D, Peck AJ, Nichols WG, et al. Safety and tolerability of oseltamivir prophylaxis in hematopoietic stem cell transplant recipients: a retrospective casecontrol study. Clin Infect Dis 2007;45:187–93.)

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Pimp Notes vol. 3

Still nailing every pimp question? Thumbs up

Over the last four years, I’ve started a small collection of questions that I repeatedly gotten pimped on by various attendings from many different services. We at QuickHits decided to empower the med student by starting a weekly post with a number of high yield questions along with some you-know-it-or-you-don’t type questions that you can impress some attendings with.

We hope this allows our readers to continue to build a thorough knowledge base. Give a shot at this week’s volume of pimp notes.
See how many you get right. Leave some comments!:

  • Most common elbow fracture in adults? In pediatrics?
  • How much fluid is needed to see a pulmonary effusion on radiograph?
  • Characteristics needed to diagnose appendicitis on abdominal ultrasound?
  • What are the types of den’s fractures?
  • What is a Segond fracture? What other injury is associated w/ Segond fractures?
  • Pediatric patient presents at birth with cyanosis that is cyclical. When baby cries, his respiratory distress resolves. Dx?
  • Four basic interventions to lower ICP?
  • Diagnosis, complications, and basic management:

    Click for larger view

CONTINUE READING FOR ANSWERS

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Pimp Notes vol. 2

How you feel when you dominate every pimp question thrown at you

Over the last four years, I’ve started a small collection of questions that I repeatedly gotten pimped on by various attendings from many different services. We at QuickHits decided to empower the med student by starting a weekly post with a number of high yield questions along with some you-know-it-or-you-don’t type questions that you can impress some attendings with.

We hope this allows our readers to continue to build a thorough knowledge base. Give a shot at this week’s volume of pimp notes.

I’m on my radiology rotation right now, so this post is heavy on radiology pimping. I picked most things that are very relevant to the ED. Thanks to Radiopaedia for most of the images!

See how many you get right. Leave some comments!:

  • Diagnosis of this pelvic ultrasound finding (click for larger view):

  • What  are the five basic radiographic densities from least to most dense?
  • How can you assess for proptosis from a head CT?
  • Diagnosis? (click for larger view):
  • What is Rigler’s sign?
  • What is the x-ray measurements used to assess if bowel is dilated?
  • Diagnosis? What is the significance of this finding? click for larger size image

CONTINUE READING FOR ANSWERS

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Pimp Notes vol. 1

 When the Attending goes into rapid fire pimp mode

 And you get them ALL RIGHT!

Over the last four years, I’ve started a small collection of questions that I repeatedly gotten pimped on by various attendings from many different services. We at QuickHits decided to empower the med student by starting a weekly post with a number of high yield questions along with some you-know-it-or-you-don’t type questions that you can impress some attendings with.

We hope this allows our readers to continue to build a thorough knowledge base. Give a shot at the first volume of pimp notes.

See how many you get right. Leave some comments!:

  • Highly sensitive physical exam test for mandibular trauma/fracture?
  • ST Segment elevation in right sided V4 lead is high suggestive of?
  • Most severe complication (and most common cause of death) in ITP?
  • Metabolic causes of acute confusion?
  • Pneumonia classically associated w/ bullous myringitis?
  • Diagnosis?:

click for larger view.

Case:
26 year old male presents with his elbows, wrist, and fingers locked in flexion. He started having an exacerbation of his anxiety attacks about 4 hours ago. When seen in the ED, he is hyperventilating and complaining of tingling in his fingers and inability to relax his hands.

  • Diagnosis?
  • Pathophysiology?
  • Treatment?

CONTINUE READING FOR ANSWERS

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“Boxer’s Fracture” and “Fight Bite”

Quick Hits:

Fifth Metacarpal Neck fracture (aka Boxer’s fracture)

  • usual mechanism of injury with metacarpal neck fractures involves direct trauma to a clenched fist
  • Dorsum of the hand is swollen and bony tenderness is found over the fractured metacarpal.
  • Three views of the hand (anteroposterior (AP), lateral, and oblique) adequately display metacarpal neck fractures
  • Angulation occurs in an apex dorsal direction due to the pull of interosseous muscles.
  • Functional bracing with custom or off-the shelf orthoses are effective and commonly used in the management of metacarpal neck fractures
  • Lacerations at the site of trauma (“fight bites”) are common and predispose to infection.

Closed Fist infection (aka Fight Bite)

  • present with small wounds overlying the metacarpophalangeal joints (skin breaks over the knuckle when punching face and hitting teeth) – most comonly third, fourth, and/or fifth MCP
  • highly prone to infection given the proximity of the skin over the knuckles to the joint capsule
  • Clinical manifestations of bite wound infections may include fever, erythema, swelling, tenderness, purulent drainage and lymphangitis
  • Deep bite wounds near joints warrant AP and lateral plain radiographs to evaluate for disruption of bone or joints and evidence of foreign bodies
  • Treatment:
    • no signs of infection = empiric Augmentin (amoxicillin-clauvanate) 875/125mg PO BID x5days
    • signs of infection = empiric Unasyn (ampicillin-sulbactam) 1.5-3g IV q6
    • Tetanus and rabies prophylaxis should be provided as indicated

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Small Bowel Obstruction

Quick Hit:

  • Etiology:
    • Most common = Adhesions (post-abdominal surgery)
    • Other causes = hernia, malignancy, intraluminal stricture, intussusception, foreign body, duodenal hematoma
  • Symptoms
    • colicky/paroxysmal abd pain w/ episodic, hyperactive bowel sounds, diffuse abd tenderness, bilious vomit
    • failure to pass stool or flatus = signs of complete bowel obstruction
  • Diagnosis: dilated loops on x-ray, dilated fluid filled loops (air-fluid levels) on CT Abdomen
  • Management:
    • IV fluid resuscitation w/ electrolyte repletion
    • Complete obstruction, or signs of peritonitis = surgical emergency
    • Partial obstruction: non-operative management (NG tube decompression, close observation)
  • Complications: strangulation
    • Signs of strangulation = metabolic acidosis from lactic acidosis secondary to ischemic necrosis caused by strangulation

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