by Dr. Anton Helman
Emergency Medicine Cases – Where the Experts Keep You in the Know. For show notes, quizzes, videos and more learning tools please visit emergencymedicinecases.com
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Publishing Since
3/9/2010
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April 21, 2025
Emergency medicine experts Zafar Qasim, Andrew Petrosoniak, Justin Morgenstern, Kiran Rikhraj, Anand Swaminathan, Andrew Tagg, and Jesse McLaren discuss whole blood transfusions, calcium pre-treatment, resuscitative thoracotomy, uterine casts, and occlusion MI ECG interpretation.
April 1, 2025
Dr. Lauren Westafer, Dr. Justin Morgenstern, Dr. Bourke Tillman and Anton Helman discuss risk stratification and management strategies for intermediate-risk pulmonary embolism in the emergency department, highlighting critical decision points and lifesaving interventions in this interview
March 11, 2025
Topics in this EM Quick Hits podcast<br /> <a href="https://emergencymedicinecases.com/about/experts-bios/">Stephen Freedman</a> on pediatric bloody diarrhea, S-TEC and hemolytic uremic syndrome (1:06)<br /> <a href="https://emergencymedicinecases.com/about/experts-bios/">Justin Morgenstern</a> on the evidence for IM epinephrine in out of hospital cardiac arrest (27:04)<br /> <a href="https://emergencymedicinecases.com/about/experts-bios/">Matthew McArther</a> on recognition and ED management of dengue fever (33:56)<br /> <a href="https://emergencymedicinecases.com/about/experts-bios/">Andrew Petrosoniak</a> on imaging decision making in trauma in older patients (47:20)<br /> <a href="https://emergencymedicinecases.com/about/experts-bios/" target="_blank" rel="noopener">Brit Long & Michael Gotlieb</a> on recognition and management of TTP (59:10)<br /> <br /> Podcast production, editing and sound design by Anton Helman<br /> Podcast content, written summary & blog post by Brandon Ng, edited by Anton Helman, March, 2025<br /> Cite this podcast as: Helman, A. Freedman, S. Morgenstern, J. McArther, M. Petrosoniak, A. Long, B. Gotlieb, M. EM Quick Hits 63 - S-TEC and HUS, IM Epinephrine in OHCA, Dengue, Geriatric Trauma Imaging, TTP. Emergency Medicine Cases. March, 2025. https://emergencymedicinecases.com/em-quick-hits-march-2025/. Accessed March 11, 2025.<br /> Pediatric bloody diarrhea: Shiga Toxin Producing E. Coli (S-TEC) and HUS<br /> Consider obtaining a stool specimen or rectal swab in the ED for PCR testing (not culture) to detect S-TEC, Salmonella, Shigella, and Campylobacter.<br /> Which children with bloody diarrhea require bloodwork? Most children with blood in stool do not require blood work. Indications for bloodwork include:<br /> <br /> * Hemodynamic instability<br /> * S-TEC is high on your differential (bloodwork may be useful as baseline)<br /> * Recent travel with bloody diarrhea and fever<br /> * Close contact with S-TEC cases (~10% household transmission rate)<br /> <br /> When to suspect S-TEC?<br /> <br /> * Severe crampy abdominal pain<br /> * >15-20 small frequent, mucousy, bloody stools per day<br /> * Low grade fever<br /> * Signs of microangiopathy (e.g. petechiae, jaundice)<br /> * Endemic area<br /> <br /> <br /> <br /> <br /> Children generally do not require stool O&P for acute diarrhea but should be considered for chronic abdominal pain, chronic diarrhea, or failure to thrive.<br /> When to test for C.difficile? There is a high carriage rate of C. diff (up to ~50% in children under 2 years old). Consider C. diff testing only in children with risk factors such as recent antibiotic use or hospitalization, or as a second line test on follow up if bloody diarrhea persists that is not noted to be from another bacterial etiology.<br /> Why is it important to recognize S-TEC?<br /> A complication of S-TEC infection is Hemolytic Uremic Syndrome (HUS), caused by Shiga toxin accumulation in the kidney which leads to the HUS triad: acute kidney injury, hemolysis, and thrombocytopenia.<br /> <br /> * Shiga toxin 2 (STX2) is specifically associated with a 15-20% risk of HUS in children <5 years<br /> <br /> * HUS development increases risk of dialysis to 50-60% within 1 week<br /> * Differentiating between STX1 (<1% risk of HUS) and STX2 toxin can help risk-stratify patients<br /> <br /> <br /> <br /> How to risk stratify a positive STEC result:<br /> <br /> * Assume blood in stool to be STX2 producing STEC until proven otherwise (non-bloody STEC unlikely making Shiga toxin 2 and unlikely to cause HUS)<br /> * Determine duration of diarrhea: HUS develops a median of 7 days after diarrhea onset<br /> <br /> * Diarrhea >10 days = low risk of HUS<br /> <br /> <br /> * Determining if toxin result is STX2+ (high risk)<br /> <br /> How to manage high risk patients with confirmed S-TEC?<br /> <br /> * Manage dehydration aggressively (volume depletion is associated with adverse outcomes in H...
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