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Core EM - Emergency Medicine Podcast

Episode 153.0 – Morning Report Pearls VI

Jul 9, 2018
Dive into thrilling insights from Bellevue's morning report series! Discover the vital signs to watch for in immunocompromised patients, particularly with end-stage renal disease. Learn about the urgency and treatment of Fournier's gangrene—a life-threatening infection that demands swift action. Explore the necessity of thorough evaluations for intoxicated patients, especially those with head trauma, alongside essential imaging practices. This podcast is packed with critical knowledge for emergency medicine!
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ADVICE

Immunocompromise & Back Pain Imaging

  • Treat patients with back pain and immunocompromise seriously by considering advanced imaging promptly.
  • MRI is the best imaging to detect spinal epidural abscesses, discitis, and osteomyelitis in these patients.
INSIGHT

Labs Are Unreliable for Spinal Diagnosis

  • Lab tests like WBC, ESR, and CRP are unreliable to diagnose or exclude vertebral infections.
  • MRI remains essential because labs can be normal or nonspecific in serious spinal infections.
ADVICE

Urgent Management of Fournier's Gangrene

  • Quickly identify Fournier's gangrene by signs like rapid erythema spread, bullae, and pain disproportion.
  • Begin aggressive resuscitation, broad-spectrum antibiotics, and urgently involve an experienced surgeon for prompt debridement.
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