Furuncles (boils) are skin abscesses caused by staphylococcal infection, which involve a hair follicle and surrounding tissue. Carbuncles are clusters of furuncles connected subcutaneously, causing deeper suppuration and scarring. They are smaller and more superficial than subcutaneous abscesses. Diagnosis is by appearance. Treatment is warm compresses and often oral antistaphylococcal antibiotics.
Suspect a furuncle if a nodule or pustule involves a hair follicle and discharges necrotic tissue and sanguineous pus, particularly if on the neck, breasts, face, or buttocks.
Culture furuncles and carbuncles.
Drain lesions.
Prescribe antibiotics effective against methicillin-resistant Staphylococcus aureus (MRSA) for patients who are immunocompromised, febrile, or at risk of endocarditis; for lesions < 5 mm that do not resolve with drainage; and for lesions that are > 5 mm, multiple, or expanding.
Source ... MSD manual
Suspect a furuncle if a nodule or pustule involves a hair follicle and discharges necrotic tissue and sanguineous pus, particularly if on the neck, breasts, face, or buttocks.
Culture furuncles and carbuncles.
Drain lesions.
Prescribe antibiotics effective against methicillin-resistant Staphylococcus aureus (MRSA) for patients who are immunocompromised, febrile, or at risk of endocarditis; for lesions < 5 mm that do not resolve with drainage; and for lesions that are > 5 mm, multiple, or expanding.
Source ... MSD manual
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SAH Emergency Management:
1. ๐ซ Avoid Hypotension:
- Maintain MAP>80, CPP 60 (ICP<20)
- IV Fluids, Pressors if needed
2. ๐ฉธ Hypertension Management:
- SBP <160 reasonable; <140 may improve outcomes
- Pain control, sedation before antihypertensives
3. ๐ Stop/Reverse Anticoagulation:
- Coumadin โ Kcentra/FFP + Vitamin K
- Aspirin โ DDAVP
- Plavix โ Platelets
- Dabigatran โ Idarucizumab
4. ๐ Nimodipine:
- Improves outcomes, 60mg q4hr PO/NGT, monitor BP
5. ๐งช Magnesium Sulfate:
- Controversial, 2-2.5 mmol/L
6. ๐ Seizure Prophylaxis:
- Short course, choose Phenytoin/Levetiracetam/etc.
7. ๐ Glucocorticoid Therapy:
- Controversial, no clear benefit/harm
8. ๐ฌ Glycemic Control:
- Consider in prolonged ED stays
9. ๐๏ธ Elevate Bed Head
10. ๐ง Aneurysm Treatment:
- Surgical clipping, coiling, short-term antifibrinolytics
๐ก๏ธ Intubation:
- Neuroprotective approach, Lidocaine, Fentanyl, Sedation (Etomidate/Propofol)
1. ๐ซ Avoid Hypotension:
- Maintain MAP>80, CPP 60 (ICP<20)
- IV Fluids, Pressors if needed
2. ๐ฉธ Hypertension Management:
- SBP <160 reasonable; <140 may improve outcomes
- Pain control, sedation before antihypertensives
3. ๐ Stop/Reverse Anticoagulation:
- Coumadin โ Kcentra/FFP + Vitamin K
- Aspirin โ DDAVP
- Plavix โ Platelets
- Dabigatran โ Idarucizumab
4. ๐ Nimodipine:
- Improves outcomes, 60mg q4hr PO/NGT, monitor BP
5. ๐งช Magnesium Sulfate:
- Controversial, 2-2.5 mmol/L
6. ๐ Seizure Prophylaxis:
- Short course, choose Phenytoin/Levetiracetam/etc.
7. ๐ Glucocorticoid Therapy:
- Controversial, no clear benefit/harm
8. ๐ฌ Glycemic Control:
- Consider in prolonged ED stays
9. ๐๏ธ Elevate Bed Head
10. ๐ง Aneurysm Treatment:
- Surgical clipping, coiling, short-term antifibrinolytics
๐ก๏ธ Intubation:
- Neuroprotective approach, Lidocaine, Fentanyl, Sedation (Etomidate/Propofol)
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Syncope - transient loss of consciousness caused by transient global cerebral hypoperfusion with rapid onset, short duration and spontaneous complete recovery; MCC of syncope (mnemonic) โ> HEAD HEART VESSELS