Measles redux!

A quick search of for the keyword measles brings up a solitary post from 2015, and it’s not actually about measles. With all the attention that measles has been getting in the news recently, now seems like a great time to revisit measles as a disease process, and go a little deeper than justRead more

In honor of a rosh review question that I got wrong, lets review Lyme disease!   Lyme disease is caused by the spirochete Boriella burgdorferi, transmitted to humans through tick bites from ixodes ticks. Location: US, endemic in NE coast, midatlantic region, and north central states. Transmission: transmission of the spirochete occurs during feeding whichRead more

Vanc + Zosyn and acute kidney injury

Vancomycin and Piperacillin-tazobactam (Zosyn) are two widely used broad spectrum antibiotics most ED providers use severe infections and especially undifferentiated sepsis. These antibiotics together synergistically fight off  MRSA, Pseudomonas, and other dangerous gram negative and gram positive infections for our sick patients.  Often times we use Vanc and Zosyn without considering other antibiotic therapy optionsRead more

Meningitis Prophylaxis

Have you ever taken care of really critical, undifferentiated patient, only later to find out that they were diagnosed with a serious, contagious illness? We are exposed to innumerable pathogens each day in the ED, but there are only a few that necessitate antimicrobial prophylaxis and even fewer that require prophylaxis from simply being veryRead more

Abscess in need, pus indeed

So you thought I&Ding your abscess was enough?  Or your attending told you….no cellulitis so no antibiotics?  WRONG! A recent double-blinded randomized-controlled trial of outpatient children and adults with abscesses <= 5cm who had I&D performed with either clindamycin or bactrim had higher cure rate at 7-10 days compared to the placebo group that hadRead more

Absolute Lymphocyte Count as a Predictor of CD4

An HIV positive patient presents to the ED but doesn’t know his CD4 count. He hasn’t been taking his HAART and you’re rightfully concerned that he might be susceptible to opportunistic infections. Unfortunately, you can’t find any information about how immunosuppressed he is. Is there a way to estimate his CD4 count? Luckily, there is!Read more

Ticked off

Today’s TR pearl is brought to you by Drs. Shearer, Hernandez, Sun and O’Halloran and summer in the Northeast. The weather is warm and people are flocking to the great outdoors. This means…ticks, as well as the tick borne diseases they may carry. For how to remove a tick, see Dr. Paulis’s excellent clinical pearlRead more

Buruli Ulcer

The following scenario is based on a case that was seen in the Sinai ED this past week. A 52 yo M with hx of poorly controlled DM and HTN p/w rapidly progressing ulcer over the past 3 weeks of right lower extremity.  He has been afebrile and has normal vital signs in the ED.  OfRead more

The 52 in 52 Review: Steroids for Bacterial Meningitis

De Gans J, Van de Beek, D. Dexamethasone in adults with bacterial meningitis. New Engl J Med. 2002;347(20):1549-56.   What we already know about the topic: Bacterial meningitis is a dangerous condition with significant associated morbidity and mortality. Survivors often suffer neurologic sequelae. Bacterial meningitis frequently affects people who were previously healthy and high-functioning.  Read more

The 52 in 52 Review: CRB-65 predicts death from community-acquired pneumonia

“I quit school in the sixth grade because of pneumonia. Not because I had it, but because I couldn’t spell it.” – Rocky Graziano   Article Citation: Bauer TT, Ewig S, Marre R, Suttorp N, Welte T; CAPNETZ Study Group. CRB-65 predicts death from community-acquired pneumonia. J Intern Med. 2006 Jul;260(1):93-101. PMID: 16789984   What weRead more