Nasal Endoscopy for Urgent and Complex ED Cases
Fiberoptics and endoscopy have changed the way we treat patients in the emergency department. Endoscopes are relatively easy to use, and can aid your diagnosis and treatment plan. Endoscopy may be useful in urgent cases, such as epistaxis, nasal foreign bodies, and ear debridement. It may also be helpful when dealing with more complicated presentations and critically ill patients, such as those with Ludwig's angina, epiglottis, tracheostomies, or those who need intubation.Fiberoptic tools are not just for surgeons and consultants. The endoscope has many uses in the emergency department, and we have a few tips and tricks...
Source: The Procedural Pause - October 28, 2020 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Penicillin allergy, probably not
The current issue of JAMA has a wonderful review of penicillin allergy. This conclusion is important:
Many patients report they are allergic to penicillin but few have clinically significant reactions. Evaluation of penicillin allergy before deciding not to use penicillin or other ?-lactam antibiotics is an important tool for antimicrobial stewardship.
This concept has great importance. Almost every time I give a pharyngitis talk, someone asks me about second-line antibiotics for patients with “penicillin allergy”. Since penicillin (or amoxicillin) work well against group A strep, group C/G strep and Fus...
Source: DB's Medical Rants - January 20, 2019 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
If I were writing sore throat guidelines
Several tweets asked me to answer this question. How would I rewrite sore throat guidelines? Obviously I am biased. So this is my opinion and I am sticking to it!
I would not change anything about pre-adolescents. Group A strep is the most important bacterial infection and using rapid tests with backup cultures makes sense.I would change the guidelines for adolescents and young adults. I would treat patients having Centor scores of 3 or 4 with either penicillin or amoxicillin (augmentin would be fine). I would probably treat some 2s if they looked very ill. I would never use macrolides. If the patient is truly penicilli...
Source: DB's Medical Rants - December 29, 2018 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
More evidence on suppurative complications from Fusobacterium necrophorum tonsillitis
This study adds to our clinical understanding of the devastating potential of this gram negative anaerobic bacteria. We have previously found that FN pharyngitis has the same clinical presentation as strep pharyngitis. Our microbiome study showed that patients with more severe clinical pharyngitis (defined as Centor scores of 3 or 4) differed between group A strep and Fusobacterium necrophorum. The tonsils with FN infection had a less bacterial diversity – this means that FN overwhelms the microbiome in many such patients.
These findings suggest that FN more likely causes suppurative complications. We know from th...
Source: DB's Medical Rants - December 29, 2018 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Thoughts on a 23-year-old athlete dying from the Lemierre Syndrome
K-State football team to honor rower Samantha Scott, who died of Lemierre’s Syndrome
Every time I read such a story my heart breaks, a small piece each time. More physicians have become aware of the Lemierre syndrome. We must also educate patients and families that sore throats in adolescents and young adults can become life threatening.
Why did she die? The article does not have enough detail to develop a firm conclusion. I can speculate on several reasons from multiple discussions with both survivors and families of adolescents who died. We also have some unpublished survey data that informs my speculations.
Wh...
Source: DB's Medical Rants - November 3, 2018 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Some thoughts on clinical judgement
Thus far I have recorded 8 podcasts for Annals on Call, 4 of which have already been published. The term and concept of clinical judgement enters the conversations repeatedly. Each podcast has had a different guest, yet in most of these conversations I have heard clinical judgement invoked. What is clinical judgement? Do we just use the term when we want to stray from protocol or algorithm? I found this definition which gets us part way to an understanding.
For purposes of description, it can be considered the sum total of all the cognitive processes involved in clinical decision making. It involves the appropria...
Source: DB's Medical Rants - September 20, 2018 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
My approach to acute pharyngitis 2018
First, we must define acute pharyngitis – no more than 3-5 days of symptoms.
Second, we should understand that pre-adolescent pharyngitis has major differences form adolescent/you adult pharyngitis.( Mitchell, M. S., Sorrentino, A., & Centor, R. M. (2011). Adolescent pharyngitis: a review of bacterial causes. Clinical Pediatrics, 50(12), 1091–1095. http://doi.org/10.1177/0009922811409571 ) Here are the differences:
Pre-adolescent pharyngitis really is group A strep vs viral
Adolescent pharyngitis has a much broader differential – GAS, Group C/G strep, Fusobacterium necrophorum, infectious mononucleosis...
Source: DB's Medical Rants - September 3, 2018 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Dr. Jonathan Cusack versus the General Medical Council
By SAURABH JHA
I spoke with Dr. Jonathan Cusack, consultant neonatologist at Leicester Royal Infirmary (LRI), and former supervisor and mentor of Dr. Bawa-Garba, the trainee pediatrician convicted of manslaughter for delayed diagnosis of fatal sepsis in Jack Adcock, a six-year-old boy with Down’s syndrome. We had drinks at The George, pub opposite the Royal Courts of Justice.
In the first part of the interview we discussed the events on Friday February 18th, 2011, the day of Jack presented to LRI. In the second part of the interview we talk about the events after fatal Friday – how the crown prosecution service go...
Source: The Health Care Blog - August 12, 2018 Category: Consumer Health News Authors: at RogueRad Tags: NHS #BawaGarba @roguerad Source Type: blogs
The Doctor Who Thwarted the Charge of the General Medical Council- Part 2
By SAURABH JHA
Saurabh Jha
This is the second part of Dr. Jha’s conversation with Dr. Jonathan Cusack, who was the former supervisor and mentor of Dr. Bawa-Garba, a pediatrician convicted of manslaughter of fetal sepsis in Jack Adcock. Read the first part of this series here.
Dr. Jonathan Cusack versus the General Medical Council
I spoke with Dr. Jonathan Cusack, consultant neonatologist at Leicester Royal Infirmary (LRI), and former supervisor and mentor of Dr. Bawa-Garba, the trainee pediatrician convicted of manslaughter for delayed diagnosis of fatal sepsis in Jack Adcock, a six-year-old boy with Do...
Source: The Health Care Blog - August 12, 2018 Category: Consumer Health News Authors: at RogueRad Tags: NHS #BawaGarba @roguerad Source Type: blogs
The Doctor Who Thwarted the Charge of the General Medical Council – Part 1
By SAURABH JHA
After Dr. Hadiza Bawa-Garba was convicted for manslaughter for delayed diagnosis of fatal sepsis in Jack Adcock, a six-year-old boy who presented to Leicester Royal Infirmary with diarrhea and vomiting, she was referred to the Medical Practitioners Tribunal (MPT). The General Medical Council (GMC) is the professional regulatory body for physicians. But the MPT determines whether a physician is fit to practice. Though the tribunal is nested within the GMC and therefore within an earshot of its opinions, it is a decision-making body which is theoretically independent of the GMC.
The tribunal met in 2017, 6 ...
Source: The Health Care Blog - August 5, 2018 Category: Consumer Health News Authors: at RogueRad Tags: NHS #BawaGarba @roguerad Source Type: blogs
Tropical Travel Trouble 011 Tonsillitis and the Bull
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog
aka Tropical Travel Trouble 011
Peer Reviewers: Dr Jennifer Ho, ID physician QLD, Australia and Dr Mark Little, ED physician QLD, Australia.
You are working in far North Queensland and encounter a 20 year old Indigenous man with tonsillitis on your ED short stay ward round. He has been receiving IV penicillin and metronidazole overnight but is deteriorating and now cannot open his mouth beyond 1.5cm, and has a swollen neck (some might say ‘Bull neck’). In add...
Source: Life in the Fast Lane - July 25, 2018 Category: Emergency Medicine Authors: Amanda McConnell Tags: Clinical Cases Tropical Medicine antitoxin bull neck c. diphtheriae c.ulcerans DAT pseudomembrane vaccine Source Type: blogs
Tropical Travel Trouble 011 Tonsillitis and the Bull
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog
aka Tropical Travel Trouble 011
Peer Reviewers: Dr Jennifer Ho, ID physician QLD, Australia and Dr Mark Little, ED physician QLD, Australia.
You are working in far North Queensland and encounter a 20 year old Indigenous man with tonsillitis on your ED short stay ward round. He has been receiving IV penicillin and metronidazole overnight but is deteriorating and now cannot open his mouth beyond 1.5cm, and has a swollen neck (some might say ‘Bull neck’). In add...
Source: Life in the Fast Lane - July 25, 2018 Category: Emergency Medicine Authors: Amanda McConnell Tags: Clinical Cases Tropical Medicine antitoxin bull neck c. diphtheriae c.ulcerans DAT pseudomembrane vaccine Source Type: blogs
Sore throats – #thefineprint
Saying that sore throats are simple has become a trope, as thus many physicians do not seem to have a thoughtful approach to adolescent/young adult pharyngitis. As the author of the Centor Score, I would like you to consider these points when seeing sore throat patients.
The most important use of the score involves identifying those who need neither diagnostic tests nor antibiotics. Too many urgent cares run a group A rapid strep test on everyone with a sore throat.
The score is meant for acute (3 day or less) sore throat symptoms.
The score stratifies adolescent/young adults with bacterial pharyngitis – group A...
Source: DB's Medical Rants - June 18, 2018 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
The Fusobacterium story as of 2018 – a very long post
Conclusion:Fusobacterium necrophorum–positive pharyngitis occurs more frequently than group A ?-hemolytic streptococcal–positive pharyngitis in a student population, and F. necrophorum–positive pharyngitis clinically resembles streptococcal pharyngitis.
Since Fusobacterium necrophorum recovery increased as the Centor score increased we argued that we had sufficient circumstantial evidence that this organism explained many of the 3s and 4s and that the score really reflected bacterial pharyngitis. Our subsequent recently published paper on the pharyngitis microbiome strongly supports our contentions.
So where ...
Source: DB's Medical Rants - February 11, 2018 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Funtabulously Frivolous Friday Five 220
LITFL • Life in the Fast Lane Medical Blog
LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog
Just when you thought your brain could unwind on a Friday, you realise that it would rather be challenged with some good old fashioned medical trivia FFFF…introducing Funtabulously Frivolous Friday Five 220.
Question 1
What deceased Nobel Prize winner’s eyes are currently sitting in a safety deposit box in New York City?
+ Reveal the Funtabulous Answer
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Source: Life in the Fast Lane - December 29, 2017 Category: Emergency Medicine Authors: Neil Long Tags: Frivolous Friday Five Albert Einstein Clutton's joints diabetes erysipelas eyes glucose holy fire Lattimer Napoleon Bonepart New York nintendo penis St Anthony's Fire syphilis Source Type: blogs
