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practice updates

Intern Report Collection

Our ongoing intern report series is the product of first-year EM residents at UT Southwestern exploring clinical questions they have found to be particularly intriguing. For med students & junior residents - if you haven't encountered these issues yet, you will!

practice updates

Ask Me Anything with Scott Weingart, MD (@emcrit)

Live Blog Ask Me Anything with Scott Weingart
 

practice updates

D-List Superbugs: Influenza

Influenza is spread primarily through large respiratory droplets or contamination of surfaces. About 4 days after exposure patients will typically start to develop an abrupt onset of fever, headache, myalgias or dry cough—generally this presentation will be considered an uncomplicated influenza illness. Symptoms usually resolve after 3-7 days from onset. Patients can have a more complicated course if they have primary influenza pneumonia, exacerbation of underlying medical conditions like COPD, or secondary bacterial pneumonia (Strep pneumoniae, Staph aureus, community-acquired MRSA, Haemophilus influenza are the more common pathogens). There is not a validated and widely used decision rule to help distinguish influenza from other viral pathogens based on signs and symptoms. We do know that there is some seasonal variance with influenza being more common in winter months. We also have laboratory tests like respiratory panels to screen for influenza. However, the poor sensitivity and uncertain utility of these tests makes their value in the typical uncomplicated influenza presentation questionable. Treatment recommendations, supported by the CDC, IDSA, and WHO have come under recent scrutiny—we should ALL be familiar with the recent data on influenza treatment. [...]

practice updates

Ask Me Anything with Rob Rogers, MD, FACEP

Live Blog Ask Me Anything with Rob Rogers, MD, FACEP
 

practice updates

Lyceum Bullets: DKA

Questions Addressed:

  • When you are suspicious for DKA do you obtain a VBG or an ABG? How good is a VBG for determining acid/base status?
  • Do you use serum or urine ketones to guide your diagnosis and treatment of DKA?
  • Do you use IV bicarbonate administration for the treatment of severe acidosis in DKA? If so, when?
  • When do you start an insulin infusion in patients with hypokalemia? Do you give a bolus followed by a drip?

practice updates

Nuances in Resuscitation Part III: Diabetic Ketoacidosis

Thus far we have discussed resuscitation in trauma and sepsis.  What distinguishes those two from the resuscitation goals in DKA is timing.  In trauma and sepsis, it’s all about early recognition, aggressive and quick optimization, and understanding all the possible treatment options at your disposal.  In the management of DKA, it’s quite the opposite.  If you remember anything from this discussion, it’s that slow and steady wins the race!  In fact, overaggressive resuscitation is what leads to the most significant morbidity and mortality in DKA patients.  Patients in DKA don’t die from the disease process – they die because we kill them! [...]