Sepsis and Pregnancy

Pregnant graffiti in Lebanon (Wikimedia)

According to an excerpt from Randi Hutter Epstein’s book Get Me Out: A History of Childbirth From the Garden of Eden to the Sperm Bank, five hundred years ago a folk healer advised Catherine de Medici, then the queen of France, to drink mare’s urine and bathe in cow manure to increase her chances of getting pregnant. And she did it. Fortunately, you won’t need mare’s urine to treat pregnant patients with sepsis. But you will need to listen to the March EM:RAP podcast or read the PDF called Sepsis and Infections in Pregnancy by Stewart Swadron MD, Gillian Schmitz MD, Rachel Bridwell MD and Brandon Carius PA.

What are the most common infections seen in pregnancy in your region? Are vital signs good indicators during maternal and fetal resuscitation? If you don’t have much time there are five quick Take Home Points for a 30-second read.

Wikimedia photo.

Who Knew? Some of the earliest women’s health books were written by monks…although they would not be my first or even seventh guess as authors. One of the most popular monk guides, Women’s Secrets, or De Secretis Mulierum, has been translated from the original text into modern language by Helen Rodnite Lemay, a medieval scholar.

Get Your Procedure Game Plan On

Perikles Kakousis, weightlifting Olympic champion. St. Louis Olympic Games, 1904. Wikicommons.

Procedures form a structural competency in our medical practices. There’s a satisfaction that goes with a well-executed procedure be it placing a chest tube or realigning an ankle dislocation. There are some bread and butter procedures we do weekly such as intubations to those that call for our expertise rarely such as a cricothyroidotomy. So how do you get your game plan on with the rarely performed procedures? Take a listen to the EM:RAP March podcast or read the pdf called Procedural Competency by Mel Herbert MD and Jestin Carlson MD for quick suggestions on how to stay on top of rarely performed procedures. You’ll be a procedural champ and win the game.

Who Knew? The most widely accepted inception date for the Ancient Olympics is 776 BC; this is based on inscriptions, found at Olympia, listing the winners of a footrace held every four years starting in 776 BC. Tradition has it that Coroebus, a cook from the city of Elis, was the first Olympic champion. (Wikipedia)

 

 

 

Giant Cell Arteritis

I’m looking at cases to post and found one that could be me…because I’m over 60. Here’s the lowdown: over 60 years old with sudden vision loss? over 60 years old with transient vision loss? over 60 years old with transient double vision? Think Giant Cell Arteritis and take a listen to the March EM:RAP podcast: Giant Cell Arteritis by Ilene Claudius MD and Edward Margolin MD.

Or take a quick look at the PDF and bring home the take home points…it’ll make you a giant in the know.

Who Knew? Tales of giants are found in many cultures. The word giant, first attested in 1297, was derived from the Gigantes (Greek: Γίγαντες[1]) of Greek mythology. (Wikipedia)

Somewhere Over the Rainbow

Dorothy’s original ruby slippers (Wikicommons)

Neonatal stools are a source of concern for parents and color changes can trigger a visit to the emergency department or outpatient clinic. What colors raise your index of concern for serious pathologies such as necrotizing enterocolitis, malrotation with midgut volvulus or intussusception? Plug in your thumb drive or roll out your CMES app and take a listen to Jess Mason MD and Jason Woods MD as they discuss the EM:RAP podcast called Neonatal Stool Rainbow. You won’t find the Wizard of Oz but you’ll take home some knowledge…even without your ruby slippers.

 

 

Rural Medicine: Diabetic Ketoacidosis

Glucometer. Courtesy Wikicommons.

Once a month I will comment on the Rural Medicine podcast from EM:RAP. It’s exciting to read CME that can be applied globally no matter where you live or what resources you have at hand. Diabetic Ketoacidosis (DKA) In The Village by Vanessa Cardy MD and Stuart Swadron MD can be found in the February 2019 EM:RAP podcasts or take a quick read of the PDF for bullet points.

The question of the month? How do you manage DKA when you don’t have access to labs? 

Urine dip strip. Courtesy Wikicommons.

And…is the urine ketone strip a good test?

Pediatric Wisdom

Pediatric patients at mobile clinic, Tena, Ecuador.

Each month EM:RAP offers a podcast called Pediatric Pearls. Take a listen or read the January edition titled: Pediatric Gynecology Complaints by Ilene Claudius MD and Emily Willner MD. Neonates with blood in the diaper, difficult catheterizations, and how are vaginal exams different in children are a few of the useful topics covered.

Share your experiences and advice. How does your facility manage pediatric emergencies?

 

 

How to Kill a Patient During Airway Management

Airway Management is just that…managing the airway upside down and inside out. Take a quick read of the PDF or listen to EM:RAP’s November MP3 audio podcast called Strayerisms: Fluid Filled Airway. It’ll float your boat.

Correct ET tube placement, but if you tube the esophagus, leave the ET tube in place and use it as a landmark.

According to Dr. Reuben Strayer MD, the author, there are four ways to harm your patient during airway management: failure to oxygenate; failure to ventilate; worsening perfusion; and aspiration. His suggestions are doable no matter where you practice or what resources you lack…remember…your greatest resource is knowledge.

 

 

 

Who Knew? Probably the oldest recovered boat in the world, the Pesse canoe, found in the Netherlands, is a dugout made from the hollowed tree trunk of a Pinus sylvestris that was constructed somewhere between 8200 and 7600 BC. This canoe is exhibited in the Drents Museum in Assen, Netherlands. (Not looking too seaworthy these days.)

 

 

To Give Steroids or Not: That is the Question

Steroid molecule. (Wikimedia Commons)

In Hamlet Act 3, scene 1, Shakespeare wrote; “To be, or not to be: that is the question”. Hamlets most famous soliloquy is both memorable and intriguing because he was contemplating profound ideas. Something you do every day, every shift and every hour while working…you contemplate decisions based on best practice, cutting-edge articles, and new research. One such question has haunted us for decades…to give or not to give steroids to septic patients.

Take a listen or read the August EMRAP article titled: Critical Care Mailbag: Steroids for Septic Patients by Anand Swaminathan MD and Scott Weingart MD for a fresh perspective.

On Jan 19th, 2018 the ADRENAL Trial results were published trying once and for all to answer the question of adjunctive steroids in septic shock. Take a look at this condensed version.

Rheumatoid arthritis (Wikimedia)

Who Knew? In 1948 the first patient with rheumatoid arthritis was treated with cortisone.  Between 1954 and 1958 six synthetic steroids were introduced for systemic anti-inflammatory therapy. By 1960 all of the toxic effects of chronic corticosteroid administration had been appreciated. In the 1970s the introduction of methotrexate helped restrict the dosages and indications for corticosteroids in the rheumatic diseases.

 

 

Testicular Torsion – A Convoluted Case

What do Chubby Checker and testicular torsion have in common? (Wikimedia photo)

The 14-year-old male patient complained of right lower quadrant pain which varied in intensity for 1 day. He denied nausea, vomiting or fever. The abdominal exam revealed bowel sounds and mild tenderness to palpation in the right lower quadrant without rebound. His abdominal ultrasound was inconclusive; the white blood cell count mildly elevated, and the urine microscopy normal. He was admitted for observation. Twelve hours later the patient developed a fever and severe groin pain. A genital exam revealed classic findings for testicular torsion. The testicle was not salvageable. Unfortunately, the patient was born monorchism and rendered sterile by the orchidectomy. The lesson from this case: always include a genital exam in patients with lower abdominal pain.

Can you rely on the history and physical exam to rule out testicular torsion? Is the testicle salvageable after 6 hours? Wrench yourself away from your music downloads and listen to the EM:RAP August podcast called Testicular Torsion by Rob Orman MD and Larry Mellick MD. Get an update and review on this twisted entity and you won’t spiral out of control when faced with the possibility.

Who Knew? “The Twist” is an American pop song written and originally released in 1959 by Hank Ballard and the Midnighters. It was made popular by Chubby Checker, an American rock n’ roll icon, who put his stamp on the song with the twist dance style.

So what do Chubby Checker and testicular torsion have in common? As Mr. Checker said, “Come on let’s twist again…”. Testicular torsion pain can come and go.