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As winter is upon those in the United States, make sure you are treating your patients with pneumonia using the appropriate antibiotics.   Outpatient treatment is divided among those with significant comorbidities and those without.  The inpatient regimens distinguish between hospital associated, community acquired and those requiring the ICU.… Read more

One of the newest drugs available to some EM provider is Sugammadex.  Trade name, Bridion, the drug functions as a reversal agent for Rocuronium.  An IV bolus of 16 mg/kg over 10 seconds via a central or peripheral line will reverse a single 1.2 mg/kg dose of rocuronium in approximately 3 minutes.  Although rarely used in the emergent setting, keep the dose in the back of your mind or reference on the WikEM app just incase you need to order it.… Read more

Neonatal jaundice is one of the most common reason for newborns to return the hospital.  There are many risk factors and causes, with the most important piece of the workup being distinguishing direct vs indirect hyperbilirubinemia. Direct hyperbilirubinemia points towards a usually benign cause with breast feeding, breast milk and physiologic jaundice being the most common causes and present within the first 4-7 days of life.  Useful tools for risk stratification include the Bilitool for evaluating need for phototherapy.… Read more

Cerebral venous thrombosis (CVT) is a rare disorder involving occlusion of the venous sinus (most commonly superior sagittal and lateral sinuses) .  CVT is a very difficult diagnosis with a highly variable onset that may include visual, neurologic or even infectious like symptoms.  Predisposing factors include:

• Cancer
• Pregnancy
• Local infections (otitis media, sinusitis, cellulitis)
• Hypercoagulable states
• Trauma
• Drugs (ecstasy, androgens, OCPs)
• Compression of venous sinus (tumor, abscess)

Suspect CVT in patients presenting with headache, signs of increased ICP, or focal neurologic deficits, especially if any of above predisposing factors are present.  Do not use a D-dimer to rule out CVT. The workup includes, an MRI and MRV unless there is a contraindication, then… Read more