RMSF is the most common fatal rickettsial illness in the United States.
Overall hospitalization rates are noted be at 23.4% based on aggregated reviews of case reports (Openshaw 2010.
Case fatality rate is estimated to be 5-10% overall (Biggs 2016). If treatment is delayed, case-fatality rates of 40-50% have been described for patients treated on day 8 or 9 of their illness.
Case fatality rate is highest in those over the age of 70 (Amsden 2005).
Without treatment, the case fatality rate is over 25% (Lacz 2006).
Citation: Muhammad Durrani, “Emerging Tick-Borne Illnesses: Not Just Lyme Disease Part 4 RMSF”, REBEL EM blog, November 5, 2020. Available at: https://rebelem.com/emerging-tick-borne-illnesses-not-just-lyme-disease-part-4-rmsf/.
The CFR for untreated RMSF surprised me.
And yet another reason besides bears to stay out of the woods.
Remind me to tell some of my favorite tick stories when we can all gather unmasked to enjoy some food and drink.
#2 Remember naloxone, glucose, and thiamine (NGT)
Original: Consider or give naloxone, glucose and thiamine
The number of patients presenting with opioid intoxication is growing, and the gentle reversal of patients without severe respiratory depression with naloxone is in the art of medicine – consider starting with 0.4mg and titrate to effect.
In contrast to empiric administration of glucose in the altered or ill patient, rapid assessment of glucose level with point-of-care testing is recommended.
Thiamine deficiency may be less prevalent than previously thought in intoxicated patients, but we now know that giving 100mg of IV thiamine can benefit other malnourished patients, including those with calorie-malnourishment from cancer, gastric bypass, hyperemesis gravidarum, and eating disorders. Personally, I use the ‘T’ of ‘NGT’ to remind myself not to miss alcohol withdrawal.Ten Commandments of Emergency Medicine Revisited — https://journalfeed.org/article-a-day/2021/ten-commandments-of-em-revisited
Why does this matter? I hear you thinking we underwrite life insurance, we’re not doctors. So true. But if we think like doctors we will get better at what we do by recognizing the subtleties buried within the medical charts we read. Here’s what my eyes/brain picked up.
The bold in the excerpt above are mine to illustrate how the mind of a mortality risk expert works. In Emergency Department records pay attention to the initial treatments provided which in some cases hints to a serious condition impacting mortality. Naloxone and opioids are obvious. But would you have associated the administration of IV thiamine to malnutrition or alcohol withdrawal? I thought so.
So read and research widely. You’ll always find little jewels to improve your skills and to impress your friends with. Or in my case to make Dr. Lee think his old man knows more than he actually does.
Age is a risk factor for increased morbidity and mortality in COVID-19 infections.
Elderly men have increased mortality compared to elderly women.
Elderly patients can present differently. Delirium can be the primary symptom of COVID-19 infection, as can persistent hypoxia.
Consider COVID-19 in the setting of altered mental status and geriatric falls.
Elderly patients in the ED who live in nursing homes should undergo COVID-19 testing.
Elderly individuals with COVID-19 tend to have increased lesions and lobar involvement on chest CT.
Laboratory diagnostics may differ based on age, and the geriatric population may have lymphopenia, higher CRP values, and increased D-dimer on testing.COVID-19 in the Elderly — http://www.emdocs.net/covid-19-in-the-elderly/?utm_source=feedly&utm_medium=rss&utm_campaign=covid-19-in-the-elderly
The full article takes some time to read but it’s well worth it if you are into the clinical stuff.
When should I go to my doctor? The simple answer is when you can’t breathe or can’t hold down fluids. If you are having mild symptoms (fever, body aches, dry cough), stay home, and self-isolate. By going to the doctor, you risk spreading the virus to others, including us. If you go to the ER, we will see you but, if you are only having mild symptoms, you will likely be sent home with no COVID-19 test, no treatment, and a hospital bill.
Lastly, a personal plea. Many people are stuck at home with nothing to do. While alcohol is a disinfectant of sorts, it is not going to treat COVID-19! If you are drinking, have fun, but please wear a helmet and shoulder pads so that when you fall and hit your head, you do not have to come in and see me in the ER. We already see too many alcohol-associated visits in the emergency department. In a related note, drugs will make you feel strange. If you choose to use edibles or try new things because you are idle, please don’t do drugs and come in because you feel weird. I can’t fix that. As I told a patient this week, “You are high. If you don’t like this feeling, then don’t do drugs.”
Coronavirus made simple by your friendly neighborhood emergency physician
Amen. Entire article is at the link above.
E-bikes Show Distinct Pattern of Severe Injuries
Of more than 245 million injuries reported in the study period, 130,797 involved powered-scooter accidents, accounting for 5.3 per 10,000 U.S. emergency department injuries. There were 3,075 e-bike injuries, or 0.13 per 10,000. In addition, about 9.4 million pedal bicycle injuries accounted for 385.4 per 10,000 of all emergency department injuries.
I live a short distance from one of the three major universities in Oklahoma. I’ve learned to drive defensively especially when classes are over and the streets are teeming with students. The other day in a residential 25 MPH area adjacent to campus the car in front of me suddenly hit her brakes.
Student on an e-bike ran a stop sign. She was not wearing a helmet nor did she look in either direction prior to placing herself directly in the path of a moving car.
Vaporizing and inhaling an oily liquid is bad? Go figure…
American Thoracic Society
PUBLIC HEALTH | INFORMATION SERIES
Diseases Associated with VAPI
The following patterns of lung injury have been reported with VAPI:
■■Acute eosinophilic pneumonia
■■Acute lung injury and acute respiratory distress syndrome
■■Acute and subacute hypersensitivity pneumonitis
■■Acute eosinophilic pneumonia
■■Diffuse alveolar hemorrhage
■■Respiratory bronchiolitis-associated pneumonitis
Nearly 300 New Cases of Vaping-Related Lung Disease This Week
Teen e-cigarette use doubles since 2017
Not all specialties were equal when it comes to burnout
Source: Burnout: Emergency Medicine Hit Hardest | Medpage Today