Brought to you by Dr. Clay Smith and the folks at Vanderbilt and "Keeping up with EM" have come out with a really great app. Professional looking. I'm so jealous and inspired. Check it out!
Showing posts with label app. Show all posts
Showing posts with label app. Show all posts
New free app: Upshot
Brought to you by Dr. Clay Smith and the folks at Vanderbilt and "Keeping up with EM" have come out with a really great app. Professional looking. I'm so jealous and inspired. Check it out!
Modern EM: Case 3- Get your phones out
Sometimes on off-service morning table rounds, I like to close my tired eyes and focus my ears past the voice of the attending to hear the chorus of hundreds of pieces of paper flipping, shuffling, crinkling, and folding. It's one way to pass the time when surgeons debate over issues they don't already know the answers to. Another is to get your phone out, and help answer the questions with them.
Surgeon 1: She's breast feeding.
Surgeon 2: She's on zosyn. Can she breast feed? Is that safe?
S1: I don't know.
S3: Let's ask ID.
S1: We're not consulting ID for such a simple question.
S2: We'll curbside them.
S1: Ok, call them after rounds.
Me: The WHO says it's safe. (Micromedex)
S1: The staph culture is pan-sensitive.
S2: Give her augmentin.
S3: She has a PCN allergy - anaphylaxis.
S1: I don't give keflex to anaphylactic reactions to PCN.
S3: We can't use levaquin or bactrim because she's on coumadin especially because this will be long term.
S1: So what do we use?
S2: Let's ask ID.
S1: Ok, I'll call ID today.
Me: You can use doxycycline - no listed interactions with warfarin (Micromedex)
S1: Okay, but make sure you follow her INRs closely.
S1: Her ostomy output is through the roof.
S2: We can't keep up with it. Replacing her cc per cc with IV fluids.
S3: Maybe it's the daptomycin. Is dapto like erythro? Does it give you diarrhea?
S2: I don't know.
Me: 6-12% have diarrhea. (Micromedex)
S1: 6-12% days of the week I have diarrhea too. Keep her on the dapto.
EM residents are already valued on off-service rotations for their superhuman abilities to insert IVs and use ultrasound machines. Now, we can facilitate morning rounds with our smart phones too.
This is a 3-part guest series by Dr. Timothy Peck, who is launching his own blog at ModernEM.blogspot.com. Check it out!
Modern EM: Case 1 and 2 - Strep Throat
A sister and brother, aged 7 and 14, respectively present with pharyngitis. The 7F has sore throat, cough, fever, and post-tussive vomiting for 1 day. She has posterior pharyngeal erythema, no lymphadenopathy, no exudate, no petechiae, and looks like a viral URI.
The 14M had culture confirmed GAS pharyngitis 3 weeks ago, was treated with PCN-VK and symptoms resolved. Now, he's in the ED with signs and symptoms of pharyngitis again, including dysphagia, fever, cough, posterior pharyngeal erythema, swollen tonsils, LAD, and petechiae on his hard palate.
Resources used:
I ordered cultures on each of them and then I opened up MDCalc (I have shortcuts saved to all my devices' desktops) to the Modified Centor Score for Strep Pharyngitis. The easy-to-use calculator tells me that I won't treat the 7F unless positive cultures come back, and the 14M will get empirically covered.
But what antibiotic do I give him? It seems that he failed PCN-VK. Traditionally, many have reached for azithromycin next but I had just read a plea by Dr. Ryan Radecki on his blog EM Literature of Note to stop using macrolides for strep throat based on a study out of Rush that reported cases of rheumatic fever secondary to macrolide resistance. The paper also notes as high as a 15% US single center resistance rates.
If not a z-pack, then what? I opened the EMRA Abx guide which recommended cephalexin or clindamycin. I chose cephalexin, rechecked in Micromedix the indications and dosing, and felt confident I had made the right choice. I also noted to myself that if in the future I were treating a child with a history of PCN anaphylaxis, then clindamycin would be my choice.
I went home that night, read the paper and tweeted Ryan. He and Dr. Graham Walker (MD Calc) were already having a conversation about the issue and I asked them what their second line choice of antibiotic is?
Finally, I went on my favorite quick reference resource WikEM. Their entry on strep pharyngitis was recommending azithromycin as the second line drug. I updated the site, and referenced the article.
The 14M had culture confirmed GAS pharyngitis 3 weeks ago, was treated with PCN-VK and symptoms resolved. Now, he's in the ED with signs and symptoms of pharyngitis again, including dysphagia, fever, cough, posterior pharyngeal erythema, swollen tonsils, LAD, and petechiae on his hard palate.
Resources used:
I ordered cultures on each of them and then I opened up MDCalc (I have shortcuts saved to all my devices' desktops) to the Modified Centor Score for Strep Pharyngitis. The easy-to-use calculator tells me that I won't treat the 7F unless positive cultures come back, and the 14M will get empirically covered.
But what antibiotic do I give him? It seems that he failed PCN-VK. Traditionally, many have reached for azithromycin next but I had just read a plea by Dr. Ryan Radecki on his blog EM Literature of Note to stop using macrolides for strep throat based on a study out of Rush that reported cases of rheumatic fever secondary to macrolide resistance. The paper also notes as high as a 15% US single center resistance rates.If not a z-pack, then what? I opened the EMRA Abx guide which recommended cephalexin or clindamycin. I chose cephalexin, rechecked in Micromedix the indications and dosing, and felt confident I had made the right choice. I also noted to myself that if in the future I were treating a child with a history of PCN anaphylaxis, then clindamycin would be my choice.
I went home that night, read the paper and tweeted Ryan. He and Dr. Graham Walker (MD Calc) were already having a conversation about the issue and I asked them what their second line choice of antibiotic is?
Finally, I went on my favorite quick reference resource WikEM. Their entry on strep pharyngitis was recommending azithromycin as the second line drug. I updated the site, and referenced the article.
This is a 3-part guest series by Dr. Timothy Peck, who is launching his own blog at ModernEM.blogspot.com. Check it out!
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