Max continues his weekly conference summaries. Below is the abbreviated version (edited by our webmaster)
1) Fever - only 50% of transplant patients with infection have fever, don't rely on fever!
2) Rejection rates - kidney 20%, heart and lungs 30%, liver 66%
1) Supraclavicular CVC -The landmark for needle insertion is posterior to the clavicle at the middle/medial third (point needle towards the ipsilateral sternoclavicular joint)
2) US-guided vs landmark guided CVC placement - 12% reduction in unsuccessful line attempts and 71% fewer IJ complications when US is used over a blind technique.
Developing world EM
1) Congenital hypothyroidism - failure to meet developmental milestones, thickened skin, increased abdominal girth, and macroglossia.
2) Conjunctival suffusion - red conjunctiva without inflammatory exudate. Seen in Weil's disease (severe Leptospirosis). Treatment(like any other weird disease) is doxycycline and/or penicillin G.
3) Scrub typhus -Transmitted by mites, presents with rapid onset fever, headache, altered mental status, and inoculation eschar. Again, doxycycline.
1) Ultra-simple Brugada criterion - R wave to peak time (RWPT) of > 50ms predicts ventricular tachycardia.
2) Unclear regular wide complex tachycardia origin - when in doubt, treat as ventricular tachycardia!
1) Torsades de Pointes - for polymorphic VT from long QT syndromes, after Magnesium, consider overdrive pacing and chronotropic support (isoproterenol, epinephrine).
3) Propofol infusion syndrome - acute refractory bradycardia and eventual asystole in patients on >4mg/kg/hr for two days in the presence of metabolic acidosis, rhabdomyolysis, hyperlipidemia, and fatty liver. Max continues his weekly conference summaries. Below is the abbreviated version from our webmaster.