EM Quick Hits 17 Adrenal Crisis, Strep Throat, Posterior MI, DKA Just the Facts, Ovarian Torsion Imaging, HINTS Exam, Canadian CT Head Rule

Emergency Medicine Cases

Dr. Anton Helman

Science, Courses, Medicine, Health & Fitness, Education

4.7 • 602 Ratings

🗓️ 21 April 2020

⏱️ 49 minutes

🔗️ Recording | iTunes | RSS

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Summary

Anand Swaminathan on recognition and ED management of adrenal crisis, Maria Ivankovic on indications for antibiotics in strep throat from EM Cases Course 2020, Jesse McLaren on recognition of posterior MI from ECG Cases, Justin Yan & Hans Rosenberg on just the facts of approach to DKA, Brit Long on ovarian torsion imaging myths, Walter Himmel on how to use the HINTS exam properly, and Ian Stiell on how to use Canadian CT head rules properly...

Transcript

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0:00.0	This is EMKase, EM Quick Hits podcast, where our team of experts and educators bring you clear, concise, and condensed, practice-changing knowledge on all those EM topics you may not be totally comfortable with. Cases, the latest evidence, concise, and condensed practice-changing knowledge on all those EM topics you may not
0:20.9	be totally comfortable with. Cases, the latest evidence, procedural tips and tricks, pitfalls
0:25.7	to avoid, and the key take-home points and references on the EM cases website.
0:30.6	Quick, let's get on with it.
0:32.8	First up, we have Swami on, well, I won't give it away just yet.
0:38.4	About a month ago, a patient presented to RED with fever, tachycardia, altered mental status,
0:43.4	and hypotension. Seems like a pretty straightforward sepsis case, and so we started with good
0:48.4	sepsis care, two peripheral IVs, a bolus of lactated ringers, some broad-spectrum antibiotics,
0:53.5	we did cultures,
0:54.9	we sent urine, and we obtained a chest x-ray. Unfortunately, two issues came up. The urine and chest
1:00.7	x-ray were clean, and the patient didn't improve with fluids. It's no big deal. That happens all
1:05.3	the time. We did a good check of the skin looking for a soft tissue infection and rash and didn't
1:10.1	find anything. The abdomen was soft, but we decided to for a soft tissue infection and rash and didn't find anything.
1:15.5	The abdomen was soft, but we decided to get a scan anyway, and it was clean.
1:20.3	A rush exam didn't show much either, maybe a slightly depressed ejection fraction, but nothing crazy.
1:25.7	We started norepinephrine, and we were ratcheting the doses up pretty quickly without much response.
1:29.1	Pretty soon we were up to 25 mics of Norepe, and the team was asking about adding a second presser. Anytime I'm ratcheting up my vasopressors and contemplating a
1:36.1	second one, I take a cognitive pause. What else could I be missing? There are so many things that
1:42.0	can cause non-response to depressors, and I'll include a
1:44.9	slide in the show notes that goes through my thought process on that. The list includes things like
1:49.6	beta blocker and calcium channel blocker overdose, anaphylaxis, hypokalcemia, and occult bleeding.
1:55.6	In this case, two potential endocrine issues came up as well,vere hypothyroidism and adrenal insufficiency.
	...

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