Tamingthesru
Grand Rounds Recap 9/2
Evidence-Based Medicine: Meningitis with Drs. O'Brien and Teuber
- In one study, 95% of people with meningitis had 2 of fever, headache, meningismus but only 44% had all 3
- CT prior to LP? The American College of Radiology says do it for papilledema, altered mental status, focal neuro deficit, immunocompromised stated, history of CNS disease.
Annals of B-Pod: Quick Hit Case
Fibular Head Dislocation: An Uncommon Cause of Knee Pain
The patient is a male in his 20s who was playing soccer and felt a pop in his left knee followed by pain in his left knee. He has not been able to ambulate since the injury. He has an obvious deformity to the lateral aspect of his left knee. His x-ray was read as normal. Given his pain and mechanism, there was concern for fibular head dislocation so a CT of the knee was ordered. This showed an anterior, inferior subluxation of the fibular head.
Grand Rounds Recap 8/26
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