Host: Elizabeth Esty, MD In the US, few people receive vaccination for tuberculosis (TB), a disease that hasn’t been a major killer here for many decades. But while we in the US mostly experience TB as a relatively rare but real threat in its multidrug resistant form, particularly in patients with HIV–or in Victorian novels–TB…
Read MoreAuthor: Nicholas Hatch, MD Educational Pearls: Measles has a period of infectivity starts before the appearance of the characteristic rash, up to 4-5 days A devastating consequence of measles is Subacute Sclerosing Panencephalitis (SSPE), which manifests 7-10 years after the initial measles infection SSPE is a central nervous system disease that has no cure and…
Read MorePodcast # 437 : Myasthenia Gravis Author: Gretchen Hinson, MD Educational Pearls: Myasthenia gravis (MG) is an antibody mediated autoimmune disorder against the acetylcholine receptors at the neuromuscular junctions. Bimodal age distribution (20’s-30’s: women; 60’s-70’s: men) Presents with fluctuating muscle weakness typically worse at the end of the day with upper extremities affected more…
Read MoreAuthor: Jared Scott, MD Educational Pearls: Scombroid is a type of food poisoning associated with dark fish (i.e. tuna, salmon, mackerel) that mimics anaphylaxis. Occurs through conversion of histidine to histamine by bacteria in the fish. Symptoms include flushing, lips swelling, nausea, diarrhea in setting of recent fish consumption. Treat with antihistamines. References Ridolo…
Read MoreAuthor: Nick Hatch, MD Educational Pearls: Behcet Disease is an autoimmune disease that can affect any organ system. Typical symptoms include recurrent oral and genital ulcers, but more concerning features include skin rashes, ocular problems, and strokes. Patients with Behcet disease with hypotension should have low threshold for giving steroids. References: Arlt W, Allolio B….
Read MoreAuthor: John Winkler, M.D. Educational Pearls Angioedema is immediately life-threatening due to airway obstruction. Mechanisms include allergic reaction (histamine-related) or bradykinin-related (ACE-inhibitor, C1 esterase inhibitor deficiency). The bradykinin-related mechanism will not respond to the traditional meds used for anaphylaxis. Instead, use FFP to replace depleted factors. If a patient displays signs of respiratory compromise, intubation…
Read MoreAuthor: Aaron Lessen, M.D. Educational Pearls Icatibant was introduced to treat ACE-inhibitor induced angioendema. This type of angioedema is refractory to epinephrine and antihistamines, and is likely mediated by elevated bradykinin.(which is inactivated by ATII and ACE). Icatibant initially was shown to reduce facial swelling and airway obstruction in the setting of ACE-I angioedema, but…
Read MoreAuthor: Sam Killian, M.D. Educational Pearls Anaphylaxis is common in the ED. These patients are treated and then usually watched for 4-6 hours. Biphasic happens in patients that have a complete resolution of their anaphylaxis for at least an hour, but then have a recurrence that requires pharmacologic intervention. Most of the time this happens…
Read MoreAuthor: Peter Bakes M.D. Educational Pearls: Some common causes of monoarticular arthritis include: crystal arthropathies (gout and pseudogout), infection (septic joint), reactive arthritis and acute presentations of chronic arthritides. Lyme disease usually presents with a targetoid lesion associated with constitutional symptoms The common triad of symptoms associated with reactive arthritis (aka Reiter’s Syndrome) consists of…
Read MoreRun Time: 5 minutes Author: Peter Bakes M.D. Educational Pearls: Case presentation: 18 year old otherwise healthy male presents to the ED complaining of neck stiffness, headache, and right ankle irritation. The patient recently traveled to Italy in an area endemic of Lyme Disease. The patient 2 weeks prior had a viral infection w/ rhinorrhea…
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