My original source for this episode was the MDCalc tPA contraindication guidelines which are based off older recommendations (2015). Stroke guidelines and tPA contraindications have changed and are rapidly changing. Always follow the most up to date AHA/ASA guidelines or your institutional protocol, as much of this information may be outdated. Introduction tPA is one […]

Sepsis guidelines are constantly changing. Refer to your national guidelines or institutional protocol for most up to date treatment information. Introduction Sepsis is bad and needs to be treated aggressively Confusion around multiple conflicting guidelines and requirements Surviving Sepsis Campaign recommendations CMS requirements Sepsis-3 SOFA/SIRS/qSOFA Institutional protocols Sepsis-3 Proposed Recommendations Screen for sepsis by applying […]

Physiology RBC hemoglobin breakdown -> unconjugated (indirect) bilirubin Unconjugated (indirect) bilirubin -> liver -> conjugated (direct) bilirubin Conjugated (direct) bilirubin -> Eliminated in stool Causes of Hyperbilirubinemia Increased RBC turnover Sepsis Rh incompatibility RBC disorders Maternal diabetes Scalp hematoma Decreased/slow conjugation by the liver Peaks around day 5 of life Congenital liver disorders Gilbert/Crigler Najjar […]

Clinical Presentation Incidental finding on routing CBC Petechiae/purpura Mucosal bleeding Epistaxis Gingival bleeding Hematuria Vaginal bleeding 5 Major Causes of Thrombocytopenia Thrombotic Thrombocytopenic Purpura (TTP) Clinical presentation (pentad) Thrombocytopenia Fever Microangiopathic hemolytic anemia “schistocytes” Neurologic abnormalities Renal dysfunction Physiology Low ADAMTS13 results in impaired vWF breakdown Widespread “platelet plugs” Treatment Plasma exchange Hemolytic Uremic Syndrome […]

The hardest part about this chief complaint is expanding your differential beyond gastritis!!! Step 1: Expand Your Differential Diagnosis Early appendicitis Bowel obstructions Myocardial infarction Elevated ICP Diabetic Ketoacidosis Step 2: Give a Testing Plan High yield tests to consider EKG – older adults Pregnancy test – women of child bearing age Electrolytes – most […]

Organ Failure Complications Hepatorenal syndrome (renal failure) Decreased urine output Labs show elevated creatinine Admit to hospital (high mortality) Hepatic encephalopathy (brain failure) Introduction Liver clears ammonia from body In advanced liver failure, ammonia increases Symptoms Altered mental status/confusion Asterixis Treatment Lactulose Binds ammonia and is excreted Rifaximin Eliminates bacteria responsible for producing ammonia Portal […]

Non-Accidental Trauma Estimated 10% of pediatric patients are victims of abuse Sexual abuse Physical abuse Neglect Common red flags Changing story Story that doesn’t make since Delays in seeking care Unusual bruising locations Torso Ears Neck Common tests if non-accidental trauma suspected Skeletal survey x-rays Head CT Especially if altered mental status Abdominal CT Especially […]