Today we had a wonderful conference. Thanks to our resident and attending lecturers as well as extra-special thanks our guest lecturers, Dr. Gillette and Dr. Duroseau!
Dr. Reisman’s Journal Club lecture, Summary by Dr. Reisman
Retrospective study of patients admitted for neutropenic fever at a cancer center in South Korea. Analysis yielded three points that reflect a higher potential for complications – infiltrate on CXR, platelet count <50k cells/ml, and CRP>10 mg/dl.
1. All febrile neutropenic patients should receive antibiotic prophylaxis. More information on neutropenic fever can be found on our blog here and here.
2. Only discharge febrile neutropenic patients if they have excellent follow up and meet the stringent low-risk criteria detailed in the IDSA guideline. You can see an ALiEM post summarizing this here or the actual guidelines by IDSA here
3. Febrile neutropenic patients with pneumonia tend to be sicker than patient without pneumonia
Predicting the complicated neutropenic fever in the emergency department. Moon JM, Chun BJ. Emerg Med J. 2009 Nov;26(11):802-6. doi: 10.1136/emj.2008.064865.
Dr. Duroseau’s Lecture on Patient Satisfaction, Summary by Dr. Andrew Grock
- Patient satisfaction is important and can be improved without doing more tests or giving more opioid prescriptions.
- AIDET – Acknowledge patient, Introduce yourself, Duration – manage expectations,Explanation- reasons for test and time for each test, Thank you
- Visit patients frequently and ask about their comfort level, tell them when results are in, and ask if all of their concerns were addressed.
Dr. Gillette’s Sickle Cell lecture. Summary by Dr. Andrew Grock
- Sickle cell pain crisis can be divided into three different groups
- Afebrile, active marrow – usually sternum, humerus, femur, Lumbar spine (sites of increased marrow). Will have elevated WBC/retic/ldh, and decreased hgb.
- Febrile – could be from non-sickle etiology (uri, sinusisitis, uti, PID) or from sickle-related pathology (bone/pulm/spleen infarction, fat emboli, acute chest syndrome)
- Other sickle cell event – GB dx, avascular necrosis, delayed transfusion reaction, hepatic/spenic sequestration, multi-organ system failure.
Please see article I emailed out on Sickle Cell Disease complications that Dr. Gillette referred to in his lecture.
Dr. Andrew Kopping’s M&M Lecture, Summary by Dr. Kopping
- Always keep your differential wide to prevent yourself from premature closure
- Don’t forget your stroke mimickers!! Such as: Sepsis (especially in chronically ill/old), hypoglycemia, DKA/HHS, electrolyte abnormalities, tox, migraine headache, seizure, conversion disorder, malignant HTN, encephalopathy, intracranial mass/infection/bleed, bell’s palsy
- Do a complete physical exam on every patient.
4. Click here for the JAMA article on septic arthritis here and enjoy the EBmedicine.net article on septic joints I have sent out as well.
Dr. Sage Wiener’s Toxicology Lecture, Summary by Dr. Andrew Grock
This lecture was so spectacularly chock full of pearls that I have had to narrow it down for the wrap-up.
-For management of supratherapeutic INR, click here for Chest guidelines 2012 or either of these two wonderful blogs found here(ALiEM) and here (Kings of County).
–Pt on chemotherapy (“CHOP”) with hematuria/dysuria?
– Treatment
–Pt presents with peripheral cyanosis after EGD?...hint pulse ox 85% and unchanged on 100%NRB. DIagnosis?
–Treatment?
–Reasons why treatment may fail?
Brought to you by Dr. Andrew Grock and Dr. Carl Alsup
andygrock
- Resident Editor In Chief of blog.clinicalmonster.com.
- Co-Founder and Co-Director of the ALiEM AIR Executive Board - Check it out here: http://www.aliem.com/aliem-approved-instructional-resources-air-series/
- Resident at Kings County Hospital
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