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HIV PEP – Occupational

HIV Occupational Post-Exposure Prophylaxis Regimen:   Raltegravir 400mg PO Twice Daily (Isentress®; RAL) Plus Truvada™,1 PO Once Daily [Tenofovir DF (Viread®; TDF) 300mg + emtricitabine (Emtriva™; FTC) 200mg] CDC Recommended approach: 1) Evaluate exposure: Exposures posing risk of infection transmission : Percutaneous injury Mucous membrane exposure Non-intact skin exposure Bites resulting in blood exposure to either person involved Substances posing risk of infection transmission:

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Toxidromes

US Poison Control Center Hotline 1-800-222-1222 Anticholinergic Syndrome Physiology:Inhibition of muscarinic cholinergic neurotransmission (blocking acetylcholine from binding receptors) gives these drugs their effect. Receptors are found on smooth muscle in the GI tract, bronchi, heart, salivary and sweat glands, the cilliary body of the eye, Drugs: antihistamines, sleep aids, tricyclic antidepressants, cold preparations, atropine, cyclopentalate (eye drops) Plants: deadly nightshade (belladonna), jimson weed Clinical Features: “Red as

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CT Contrast and Kidneys (FAQ)

American College of Radiology Manual on Contrast Media (download pdf): 1) Do end-stage renal patients need urgent dialysis after a CT scan with IV contrast? No “Most low-osmolality iodinated contrast media are not protein-bound, have relatively low molecular weights, and are readily cleared by dialysis. Unless an unusually large volume of contrast medium is administered, or there is substantial underlying

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Pediatric Fever Protocols

There have been several attempts at building protocols for pediatric fever in order to determine what children 3 months and younger can be discharged home. The most commonly used protocols include the Rochester, Philadelphia, and now Step-by-Step. Although there is an exceptional comparison of these protocols (Step by Step not included) from Hui et al in 2012, the most important

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Antiplatelet Therapy and Intra-cranial Hemorrhage (ICH)

Treatment: Spontaneous ICH (intra-parenchymal) Studies suggest platelets may increase poor outcomes. (PATCH trial, etc) Note: trials excluded ruptured aneurysm, SDH and EDH Traumatic ICH (SDH, EPH) If neurosurgical intervention is NOT planned, recommendation is NOT to give platelets. If neurosurgical intervention IS planned within 24 hours: Obtain platelet function testing if possible If testing is normal, patient is anti-platelet resistant

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Angioedema

Treatment:  Control airway early if tongue swelling: Consider flex/fiber optic visualization Be prepared for surgical airway Consider ketamine for awake intubation, fiber optic nasopharyngeal intubation LMA is insufficient If cause unknown, treat as histamine related with epinephrine, H1 & H2 blockers, and corticosteroids. Meds: Epinephrine- IM preferred due to longer action 0.01 mg/kg of 1:1000, max 0.5 mg IM Do

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Varicella & Pregnancy

Treatment in pregnancy: Chicken Pox Infection Immunized or Hx of past infection: exposure: nothing to do. simple rash: acyclovir 800mg PO 5x/day for 7 days severe infection or pneumonia, admit for IV acyclovir and supportive care. Not Immunized: exposure: consider VZIG, give first dose within 96 hours if possible, and up to 10 days from exposure. simple rash: acyclovir 800mg

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