3. F E A S T S T U D Y
ā¢ Iāve mentioned it before
ā¢ Essentially found shocked
septic kids in Africa did worse
with fluid boluses over
maintenance fluid
ā¢ Comment from the floor was
āyeah but theyāll all have
malaria and the fluid will make
their cerebral oedema worseā
ā¢ Fair enough
4. S H U T U P F E R G I E
ā¢ The non-anaemic and non-malaria patients were
analysed
ā¢ Found to have the same poor outcomes with fluid
boluses over maintenance fluids as the anaemia and
malaria kids
ā¢ Regardless of whether albumin or crystalloids given
5.
6.
7. S G A R B O S S A C R I T E R I A
ā¢ Smith modified Sgarbossa rule:
ā¢ At least one lead with concordant STE (Sgarbossa criterion
1) or
ā¢ At least one lead of V1-V3 with concordant ST depression
(Sgarbossa criterion 2) or
ā¢ Proportionally excessively discordant ST elevation in V1-V4,
as defined by an ST/S ratio of equal to or more than 0.20
and at least 2 mm of STE. (this replaces Sgarbossa criterion
3 which uses an absolute of 5mm)
8.
9. S E V E R E C U T A N E O U S A D V E R S E
R E A C T I O N S
ā¢ Drug hypersensitivity syndrome is the same as DRESS
ā¢ SJS/TEN
ā¢ Acute generalised exanthematous pustulosis (AGEP)
ā¢ drug induced erythroderma
ā¢ Severe, unexpected reaction to a medicine(s)
ā¢ high fever, a morbilliform skin rash
ā¢ inflammation of one or more internal organs including the liver, kidneys, lungs
and/or heart
ā¢ It generally starts two to eight weeks after taking the responsible medicine.
10. C U L P R I T S
ā¢ Allopurinol
ā¢ AEDs esp. carbamazepine, phenobarbitol, phenytoin
ā¢ Sulfonamides
ā¢ But really anything
19. C H O I C E S R A N K R A T E
1 8 G I V C 8 . 5 F R R I C 0 0 : 4 6
6 F R S H E A T H 7 F R R I C 1 : 0 0
8 . 5 F R R I C 8 . 5 F R S H E A T H 1 : 0 5
1 4 G L U M E N C V C 1 4 G I V C 1 : 3 0
7 F R R I C 6 F R S H E A T H 2 : 1 0
1 6 G I V C 1 4 G 1 3 . 3 C M I V C 2 : 1 0
2 0 G I V C 1 6 G I V C 2 : 2 0
1 4 G I V C 1 8 G I V C 4 : 2 3
8 . 5 F R S H E A T H 1 4 G L U M E N C V C 5 : 2 0
1 4 G 1 3 . 3 C M I V C 2 0 G I V C 6 : 4 7
20. C O U N T R Y W E E K
ā¢ 13yo playing football, someone stepped on his foot
while trying to spin round
ā¢ pain
21.
22. T I L L A U X F R A C T U R E
ā¢ Salter Harris III distal tibia epiphysis
ā¢ Caused by an avulsion of the anterior inferior tibiofibular ligament
ā¢ Mechanism of injury is thought to be due to an external rotation force
ā¢ 12-14yo
ā¢ A period of time exists when the lateral physis is the only portion not
fused
ā¢ An additional fracture in the posterior distal tibial metaphysis in the
coronal plane would result in aā¦?
23.
24. B A R B A R A
ā¢ 70yo lady
ā¢ sore right knee
ā¢ normal XR with GP
ā¢ moderate effusion, ROM ~70Āŗ
ā¢ No PMHx
27. W H A T A R E Y O U L O O K I N G
F O R I N T H E S Y N O V I A L
F L U I D ?
28.
29.
30.
31. C O U R S E
ā¢ D/C with NSAIDS and Dx with pseudogout
ā¢ Recalled 2 days later after bacteria grown
ā¢ Sent home by ED as patient feeling ok
ā¢ No bloods done
ā¢ Back 5 days after initial presentation with obvious
septic joint
32.
33.
34. ā¢ Unwitnessed arrest
ā¢ Initial non-VF Rhythm
ā¢ Lack of bystander CPR
ā¢ >30 min to ROSC
ā¢ >30 min of CPR
ā¢ Evidence of unresponsive hypoperfusion and microcirculatory failure:
ā¢ pH <7.2 and Lactate >7
ā¢ Age >85
ā¢ End-Stage Renal Disease (ESRD
ā¢ Non-Cardiac Causes: Cardiac arrest due to drugs, drowning, acute stroke, terminal cancer and trauma,
just to name a few non-cardiac causes, are likely to result in poor outcomes post-resuscitation.
Unfavourable for Cath
35.
36.
37. A V O I D
ā¢ All STEMI criteria patients
ā¢ excluded if sats <94%
ā¢ There was an increase in the rate of recurrent myocardial infarction in
the oxygen group compared with the no oxygen group (5.5% versus
0.9%; P=0.006)
ā¢ An increase in frequency of cardiac arrhythmia (40.4% versus 31.4%;
P=0.05).
ā¢ At 6 months, the oxygen group had an increase in myocardial infarct
size on cardiac magnetic resonance (n=139; 20.3 versus 13.1 g;
P=0.04).
38.
39. P L U G F O R A C H A R I T Y
ā¢ Iāve belonged for ~5years
ā¢ āMedics Beyond Medicineā
ā¢ For doctors who want to connect with people with
mental and physical disabilities rather than just see
them in a clinical setting
ā¢ Generally revolves around outings
ā¢ Recently featured on channel 9 news
40.
41.
42. ā¢ Emma and Dave volunteered their time
ā¢ āDanielā here has myotonic dystrophy as seen by the
tell tale baldness pattern
ā¢ āChrisā has a rare chromosomal abnormality that
means he has a compulsion to wear a cap in an
inappropriate setting
43. A G E A D J U S T E D D - D I M E R
ā¢ Wells score ā¤4
ā¢ Age ā· D-dimer (0.01mg/L)
ā¢ ie a 70yo will have an acceptable D-dimer <0.7mg/L
ā¢ Validated in multiple studies
ā¢ I think we should use it
44. C E N T O R
ā¢ History of fever
ā¢ Tonsillar exudates
ā¢ Tender anterior cervical adenopathy
ā¢ Absence of cough
ā¢ The Modified Centor Criteria add the patient's age to the criteria
ā¢ Age <15 add 1 point
ā¢ Age >44 subtract 1 point
ā¢ -1, 0 or 1 points - No antibiotic or throat culture necessary (Risk
of strep. infection <10%)
ā¢ 2 or 3 points - Should receive a throat culture and treat with an
antibiotic if culture is positive (Risk of strep. infection 32% if 3
criteria, 15% if 2)
ā¢ 4 or 5 points - Treat empirically with an antibiotic (Risk of strep.
infection 56%)
ā¢ The presence of all four variables indicates a 40 - 60% positive
predictive value for a culture of the throat to test positive for
Group A Streptococcus bacteria. The absence of all four
variables indicates a negative predictive value of greater than
80%
45. W H A T A N T I B I O T I C
ā¢ Phenoxymethylpenicllin
ā¢ Cheap, proven
ā¢ Never been a resistant GABHS to penicillin
ā¢ Good anaerobic cover just in case the patient hasā¦
46.
47. F U S O B A C T E R I U M
N E C R O P H O N U M
ā¢ lemierreās syndrome
ā¢ Thrombus of the internal jugular
ā¢ Sepsis
ā¢ Mortality of ~5%
ā¢ Not sensitive to macrolides