One of the fundamental axioms of medicine, passed down from generation of physicians to generation of physicians, “it could be syphilis” Perhaps no spirochete has garnered such infamy nor acrimony as Treponema pallidum. In this impeccably researched piece, Dr. Hall delves into a presentation of neurosyphilis, a devastating manifestation of the infection stemming from transmission of the bacterium into the central nervous system. Dr. Hall details the presenting symptoms, diagnostic approach, and emergent management of syphilis before delving into the various other forms this “great imitator” might take.Read More
The Global Health case series highlights interesting cases residents experienced while practicing abroad and takes a dive into how to identify the pathology that is crucial know to care for patients both abroad and returning. Dr. Colmer continues this year's case series with a case of an adult patient with a "textbook" rash he saw while in Tanzania.Read More
Grand rounds this week started off with a review of the EMTALA law with Dr. Hinckley, as well as some case discussion. This was followed by a presentation from our clinical pharmacists, PharmD's Nicole Harger and Madeline Stephens, on anti-epileptic medications and their uses, as well as an update on our medication supplies in the ED. Drs. Murphy-Crews and Scanlon then presented their evidenced based algorithm for the management of STEMI, followed by our combined peds EM lecture with Dr. Kevin Overmann on the evaluation of the pale child and pediatric anemia. This was followed by Dr. Ludmer's R4 case follow up/best of residency cases. The day finished up with Dr. Sim Mand presenting her clinical diagnostics lecture on the assessment and management of the non-pregnant patient with abnormal uterine bleeding.Read More
M&M with Dr. LaFollette
Case 1: Troponin Use in ESRD
- Evaluating cardiac ischemia in ESRD patients can be difficult due to baseline troponin elevations. However, all is not lost...
- Troponins can be used as a reliable marker of ischemia, even despite its collection in proximity to dialysis, if you take some things into account:
- Studies vary widely on troponin levels during dialysis, consensus being that troponin levels do not vary significantly vary with dialysis.
- Although the baseline may be abnormally elevated, ESRD patients nonetheless have a new baseline. Changes above this baseline and especially up trending troponins should trigger alarms that the patient may be having active ischemia.
- Troponin elevation in ESRD patients, even if at their baseline, is an independent risk factor for short term mortality