Wellness Wednesday: Where'd the sun go?

If you have a hankering for something lightly medical, this is your day! You have two options:

1) Check this out. Got to love new media.

2) Or, since this is my last Wednesday POD and something very special is happening next week, here's a Wacky Wellness Wednesday pearl for you all! (small medical connection at the end! links embedded throughout!)

 

THE GREAT AMERICAN ECLIPSE:

* The Thing Itself: 

- Why's this one so special? 

= it really isn't. There have been millions. But this one is the first TOTAL solar eclipse to run over the entire US since 1918. We like our astrologyonomy in 'Murika.

- Why do we care?

= They're beautiful

= Soooooo many scientific discoveries: 

* 2000ya: calculated the distance from the Earth to the Moon

* 17th century: What, solar flares are THOUSANDS of miles tall?!

* 18th century: a glass prism splits light into a rainbow because different elementsreact differently!

* 19th century: the sun's made of HOT HYDROGEN GAS (not sodium) and we discovered a new element (HELIUM!)

* 20th century: the weather is related to the sun ie. the winds changed direction during an eclipse!

* 20th century: light bending around the sun confirms the theory of general relativity (whaaaaaat?!)

* What's to come next??

* BTWs history: 

- This is a busy month for astrological phenomena as well as our exploration of the universe

= 40th anniversary of the Voyager 1 & 2 launches that gave us such wonders as:

* the first man-made object to LEAVE THE SOLAR SYSTEM

* an OCEAN below ice on Europa

* volcanoes x100 the power of earth's erupting on Io

* lightning on Jupiter!

* the discovery of 24 (twenty-four!!) new moons in the solar system

* the rings of Jupiter, Uranus, Neptune

* Eclipse in medicine:

- Eye damage: "magnifying glass on a leaf"

= takes ~1.5mins for permanent damage to be done even if not continuous unprotected observation

= cameras and regular glasses won't protect you

= can try the pinhole technique

- Changes in hormones?

- Changes in animals?

- (and if you want more: https://www.nytimes.com/guides/science/how-to-watch-a-solar-eclipse)

Mad Mondays: the meningitis edition

Meningitis: a few morsels

* Symptoms: 

- HA 90% occurence w/ meningitis

- Fever 80%

- AMS 70%

--> TWO of HA/fever/meningismus/AMS = 95% occurrence rate

* Peds vs Adults: 

- Sick kids are sick until proven otherwise

- BGM BGM BGM BGM BGM BGM BGM

- Peds more likely to show first with myalgia, cold or mottled extremities --> rapidly spreading purpura/AMS/hemodynamic instability

= TREAT IMMEDIATELY

= DO NOT WAIT FOR LP (talk to your attending)

- Consider CSF-CRP to help determine viral vs bacterial meningitis; early evidence shows it might help in stain negative samples

- With moderate suspicion, if WBC and/or ESR is elevated, treat immediately (EBM recommendation; consider this in context)

* Diagnosis:

- CSF gram stain only 60-90% sensitive

 

 

* Treatment:

- Steroids?? 

= Highly controversial. EBMedicine says consider giving to adults if HIGH SUSPICION ofpneumococcal infection  (only if you can give with first dose abx too)

- Ceftriaxone, fluids; add other abx prn

- Close contacts: rifampicin (routine) or cipro (women on OCP)

Thrilling Thursday: Peri-intubation crashing

Let's talk some peri-intubation hazards and what you should be thinking about in this setting, focusing on hypotension. If you want to really reinforce it, highly recommend the recent EmCrit podcast (a little dense but helpful) and the RebelEM adjunct (http://rebelem.com/critical-care-updates-resuscitation-sequence-intubation-hypotension-kills-part-1-of-3/).

Peri-intubation crashing:

First and always the P's

In the addition to the thorough process of P's prior to intubating a patient, consider the HOPs:

* hypotension-- we.ll focus here today

* hypoxia

* acidosis

Hypotension

* ETT/vent --> positive pressure ventilation --> increased RA pressure --> decreased venous return --> decreased preload

* most of these patients are already under a lot of stress with a huge catecholiamine surge propping up the system but also nearly depleting their stores.

* you take this away with induction; this makes ketamine often a better agent

* in shock, paralytics may take longer to work; make sure they're actually circulating

* even if starting with just a soft BP, target a  higher number than you might otherwise

* push dose pressor administration vs drip prior to intubation will help prevent peri-intubation crashing;

* epinephrine is the preference for direct cardiac effect