@adheendsa on GrepMed

3 Minute EM Pearls: Beta-Blocker Poisoning PeterboroughEM @PeterboroughEM #Diagnosis #Management #Toxicology #BetaBlocker #Beta #Blocker #Poisoning

Cephalosporins Cephalosporins are bactericidal beta-lactam antibiotics derived from the fungus Acremonlum— they disrupt peptidoglycan formation in the cell wall. They have no activity against LAME: Listeria, Atypicals (Mycoplasma/Chlamydia), MRSA and enterococci General Rule 1st Gen are predominantly active against gram-positives, with succeeding generations progressively more active against gram-negative strains (often with reduced gram-positive activity, except 4th, which are extended spectrum agents). #Cephalosporins #Generations #Classification #pharmacology #Antibiotics

Beta Lactam Antibiotic Classification UPDATE 10/2018: meropenem-vaborbactam added Penicillins, Cephalosporins, Monobactam, Carbapenems - Dr. David Serota @serotavirus #BetaLactams #Antibiotics #Penicillins #Cephalosporins #Classification #Pharmacology #Classes

Bacteremia Quick Reference - Treatment Duration Gram Negative Bacteremia: • Avoid: Aminoglycosides and tigecycline • Catheters should be removed in septic shock, suppurative thrombophlebitis, IE, infection due to P. aeruginosa • ESBL: carbapenems the drug class of choice, some strains be susceptible may to cefepime • Duration: 7 days preferred, initially IV, consider switching to oral if good bioavailability • No follow up cultures required Gram Positive Bacteremia: • S. aureus and S. lugdunensis - 14 days of IV therapy if meets all of the following criteria: - Absence of IE - No indwelling devices - Follow-up blood cultures are negative. - No fever within 48 -72 hours after initiating therapy - No evidence of metastatic infection. • Streptococcus Pneumoniae 10-14 days therapy. Consider switching to oral if good bioavailability • Enterococcus 5-7 days therapy (if repeated blood cultures drawn at 24 hours are negative) Use DENOVA score • Group C and Group G strep - 14 days therapy By @TheIDtrivia #Bacteremia #Treatment #Management #Duration #infectiousdiseases

Hypocalcemia - Diagnosis and Management PTH Independent (↑ PTH) • LOW VIT D - Deficiency: ↓ Exposure (sunlight), ↓ Intake (diet) - Activation: Liver disease, Kidney Disease (CKD) - Metabolism: Drugs (phenytoin) • NORMAL VIT D - Accelerated Bone Formation: Hungy Bone Syndrome - Calcium Sequestration: Pancreatitis, Blood Transfusions - Medications: Bisphosphonates, Denosumab PTH Dependent • INADEQUATE PTH (↓ PTH) - Iatrogenic (most common) - Surgery, Radiation - Mg+ deficiency - Infiltrative: Amyloid, TB (granuloma) - Autoimmune: APS 1 - DiGeorge Syndrome • PTH RESISTANCE (↑ PTH) - Pseudohypoparathyroidism: Alteration in PTH Signaling #Hypocalcemia #Diagnosis #Management #endocrinology #differential #algorithm

Hyperkalemia Approach #hypokalemia #algorithm #approach #diagnosis #management #treatment #medgram

Urinalysis & Urine Sodium Theophilus Protospatharius, a seventh-century physician who wrote the first manuscript focused exclusively on urine called "De Urinis", determined heating urine would precipitate proteins, documenting proteinuria as a disease state. French scholar named Gilles de Corbeil (12th century) classified 20 different types of urine, recording differences in urine sediment and color and introduced the "matula," a glass vessel in which a physician could assess color, consistency, and clarity. Following includes the complete analysis of urine: Visual exam • Color. • Clarity Dipstick test • Acidity (urine pH). • Bilirubin. • Blood (hemoglobin). • Glucose. • Ketones • Leukocyte esterase. • Nitrites. • Protein • Urine specific gravity test. Microscopic exam • Crystals. • Epithelial cells. • Bacteria, yeast and parasites (infections). • Red blood cells (RBC). • Urinary casts: • White blood cells Fractional excretion of Sodium (FE Na). [(U Na x P Cr) / (P Na x U Cr)] x 100 U = Urine, P = Plasma, Cr = Creatinine, Na = Sodium. Re-absorption and filtration accounted (Both). Should not be used with normal renal function. Acute Kidney Injury (AKI) FE Na < 1% Urine sodium < 20 mEq/L. Acute Tubular Necrosis (ATN) FE Na > 2% Urine sodium > 40 mEq/L. #Urinalysis #crystals #dipstick #nitrite #leucocyte-esterase #urine #UNa #casts #glucosuria #hematuria