There was a time, perhaps a century ago, when the only virus we really worried about was RSV. Children, snot dripping from their noses, would come in coughing, and struggling to breath and, as days grew shorter and nights grew longer we knew that bronchiolitis season was upon us once more.
But things have changed. We worry about a different virus now and there is plenty of evidence to show that the usual seasonal variations in RSV have flattened. It was heartening to see the data showing that the mid-winter peak was no more as we kept ourselves to ourselves. Non-pharmacological interventions – physical distancing, respiratory hygiene and restricted movements – meant that the scourge of the paediatric emergency department was held at bay. Until…
Postpartum hemorrhage is defined as ≥1000mL of blood loss irrespective of the delivery route, with associated shock. Remember the four “T’s”: tone (uterine atony), trauma (lacerations, uterine rupture), tissue (retained placenta, clots) and thrombin (coagulopathies). Manage the ABCs (especially two large bore IV’s for massive transfusion) and tailor treatment to the specific cause. Recommendations for balanced transfusion are derived from the trauma literature, but it is important to administer cryoprecipitate earlier to maintain a higher fibrinogen level (at term the normal level is >350mg/dL).
A 42-year-old female with no past medical history presents to the Emergency Department (ED) complaining of neck pain for 6 weeks. She has had persistent almost daily temperatures around 99F – 100F and 10 lbs of unintentional weight loss. Her pain is in the anterior neck and has gradually migrated from the right side, across the front, to the left side of her neck. Over the past week, she has begun to have the sensation of orthopnea and painful swallowing, triggering her presentation to the ED.
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