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EM@3AM: Meningococcal Disease

A 12-year-old girl presents to the ED with a 2-day history of headache and fever. The patient started vomiting with fevers this morning, and her mother was unable to wake her from her afternoon nap. She is lethargic and responds to painful stimuli with temperature of 38.2 C, blood pressure 88/65 mmHg, and HR 132 bpm. She has a petechial rash on her lower back and lower extremities, as well as resistance to neck flexion. What is the diagnosis?

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    Articles

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    EM@3AM: Alpha-2 Agonist Toxidromes

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    A 42-year-old male with a past medical history of substance use presents to the ED for chest pain, shortness of breath, nausea, and vomiting. He reported snorting fentanyl two days ago and has a remote history of IV drug use. Vital signs include 98.8°F, HR 150, RR 23, SpO2 98%
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    • electrocardiography

    ECG Pointers: CALS versus ACLS

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    What is Cardiac Advanced Life Support, and what does it entail?
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    • In the Literature, practice updates

    Policy Statement: NSTI Survival Guide

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    The Global Alliance for Infections in Surgery published a position statement comprised of recommendations for evaluation and management of necrotizing soft tissue infections. We summarize the key takeaways.
    NSTI Featured
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    emDOCs Podcast – Episode 136: Ectopic Pregnancy Myths Part 2

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    We're back with myths and misconceptions in ectopic pregnancy testing, focusing on urine and serum β-hCG and ultrasound.
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    • In the Literature

    Journal Feed Weekly Wrap-Up

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    Journal Feed covers resuscitation before intubation, insulin for hyperkalemia, and the PENG block.
    Journal Feed
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    POCUS Diagnosis of NSTI

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    How can you use POCUS to evaluate for necrotizing soft tissue infection?
    Feature POCUS NSTI
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    Trauma Resuscitation

    Primary: CABC vs MARCH (massive hemorrhage, airway, respiration, circulation, hypothermia/head injury)

    Deadly diamond of trauma: hypocalcemia, hypothermia, coagulopathy, acidosis

    If transfusing trauma patient, don’t forget the calcium

     

    If giving TXA, consider using 2g IV bolus; frees IV line, cognitively offloads, supported by TCCC guidelines

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