Podcasts about necrotizing

Send us a textOn this episode of the CMAJ Podcast, Dr. Mojola Omole and Dr. Blair Bigham discuss necrotizing fasciitis, a diagnosis that can strike fear into the hearts of clinicians due to its rapid progression and devastating consequences. The discussion builds on insights from the CMAJ practice article, “Necrotizing soft tissue infections caused by invasive group A Streptococcus,” co-authored by Dr. Saswata Deb and Dr. Stephanie Mason.Dr. Deb, an emergency physician and clinician scientist at Sunnybrook Health Sciences Centre in Toronto, outlines the key clinical signs of necrotizing fasciitis, including pain out of proportion to physical findings and rapid hemodynamic deterioration. He emphasizes the importance of considering NSTI in the differential diagnosis for cellulitis and the need for prompt surgical consultation when red flags arise. Crucially, Dr. Deb explains that no imaging or laboratory tests can definitively rule in or rule out the diagnosis—only surgical exploration can confirm it.Dr. Mason, a burn and general surgeon at Sunnybrook's Ross Tilley Burn Centre, provides a surgeon's perspective on managing these infections. She addresses common missteps in diagnosis, the need for aggressive surgical debridement, and the role of multidisciplinary care in saving patients' lives. She also discusses how surgeons can overcome their fear of creating extensive wounds, reassuring listeners that reconstruction is possible once the patient is stabilized.Together, the guests and hosts explore practical solutions to reduce delays in care, including the potential for institutional protocols—possibly a "code nec fasc"—to streamline decision-making and improve outcomes.For more information from our sponsor, go to md.ca/tax. Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.You can find Blair and Mojola on X @BlairBigham and @DrmojolaomoleX (in English): @CMAJ X (en français): @JAMC FacebookInstagram: @CMAJ.ca The CMAJ Podcast is produced by PodCraft Productions

We discuss the recognition and treatment of necrotizing fasciitis. Hosts: Aurnee Rahman, MD Brian Gilberti, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Necrotizing_Fasciitis.mp3 Download Leave a Comment Tags: Critical Care, General Surgery Show Notes Table of Contents 0:00 – Introduction 0:41 – Overview 1:10 – Types of Necrotizing Fasciitis 2:21 – Pathophysiology & Risk Factors 3:16 – Clinical Presentation 4:06 – Diagnosis 5:37 – Treatment 7:09 – Prognosis and Recovery 7:37 – Take Home points Introduction Necrotizing soft tissue infections can be easily missed in routine cases of soft tissue infection. High mortality and morbidity underscore the need for vigilance. Definition A rapidly progressive, life-threatening infection of the deep soft tissues. Involves fascia and subcutaneous fat, causing fulminant tissue destruction. High mortality often due to delayed recognition and treatment. Types of Necrotizing Fasciitis Type I (Polymicrobial) Involves aerobic and anaerobic organisms (e.g., Bacteroides, Clostridium, Peptostreptococcus). Common in immunocompromised patients or those with comorbid...

In this episode, we dive into the fascinating world of Hyperbaric medicine with Dr. Jeff Kerrie, a Hyperbaric specialist from British Columbia, Canada. Dr. Kerrie takes us through the science, history, and practical applications of Hyperbaric oxygen therapy (HBOT) as we explore the approved indications, physiological effects, and logistics of managing hyperbaric chambers. Episode Chapters: Introduction Meet Dr. Jeff Kerrie and learn about his journey in hyperbaric medicine and the unique setup of Vancouver Island's hyperbaric program. History of Hyperbaric Medicine A look at the origins of hyperbaric therapy, from 1600s pressurized chambers to its modern evolution. The Physiology of HBOT Understanding the effects of supra-physiologic oxygen pressures on microcirculation, angiogenesis, and inflammation. Indications and Evidence: Decompression Sickness The mechanisms of treating “the bends” and why HBOT works so effectively. Air or Gas Embolism Insights into diagnosing and treating air embolism, including critical resuscitation tips. Carbon Monoxide Poisoning How HBOT prevents long-term neurological damage, with considerations for pregnant patients and associated toxins like cyanide. Necrotizing Soft Tissue Infections The role of HBOT in treating Fournier's gangrene and clostridial infections alongside surgery. Crush Injuries and Anemia Exploring HBOT's utility in tissue salvage and sustaining oxygenation in severe anemia. Newer Indications: Sudden Hearing and Vision Loss The emerging role of HBOT in sudden sensorineural hearing loss and central retinal artery occlusion. Risks and Safety in the Chamber Barotrauma, oxygen toxicity, fire safety, and managing emergencies during dives. Logistics of Hyperbaric Medicine A behind-the-scenes look at hyperbaric chamber setups, patient care protocols, and equipment considerations. Closing Thoughts Dr. Kerrie's perspective on the future of hyperbaric medicine and ongoing research opportunities. Key Indications for HBOT: 1. Decompression sickness ("The Bends") 2. Air or gas embolism 3. Carbon monoxide poisoning 4. Necrotizing soft tissue infections 5. Crush injuries and compartment syndromes 6. Severe anemia (e.g., in patients unable to receive transfusions) 7. Radiation tissue injury (e.g., osteoradionecrosis) 8. Sudden sensorineural hearing loss Resources and Links: • Undersea and Hyperbaric Medical Society Approved Indications for Hyperbaric Oxygen Therapy - Oceanside Hyperbaric • Hyperbaric Medicine | © 2018 The Royal College of Physicians and Surgeons of Canada. All rights reserved. Disclaimer: This episode provides general information and is not a substitute for professional medical advice. Always consult with a specialist for specific clinical decisions.

In this episode, Dr's J and Santhosh begin their spooktober episodes with an 80 plagues devoted to flesh eating bacteria! Along the way they cover holiday creep, ancient Greek medical records, hospital gangrene in the civil war, Fournier's gangrene, syphilology, what the fascia is, common bacteria and targets, diagnosis, risk factors, the fallacy of calling something flesh eating, treatment and risks, HBO and more! So sit back as we devour and excise all the info we can on necrotizing fascitisFurther Readinghttps://www.sciencedirect.com/science/article/pii/S0736467996001977Support Us spiritually, emotionally or financially here! or on ACAST+travelmedicinepodcast.comX/Twitter: @doctorjcomedy @toshyfroTikotok: DrjtoksmedicineGmail: travelmedicinepodcast@gmail.comSpotify: https://open.spotify.com/show/28uQe3cYGrTLhP6X0zyEhTFacebook: facebook.com/travelmedicinepodcastPatreon: https://www.patreon.com/travelmedicinepodcast Supporting us monthly has all sorts of perks! You get ad free episodes, bonus musical parody, behind the scenes conversations not available to regular folks and more!! Your support helps us to pay for more guest interviews, better equipment, and behind the scenes people who know what they are doing! https://plus.acast.com/s/travelmedicinepodcast. Hosted on Acast. See acast.com/privacy for more information.

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Keep those feet dry and for the love of god, stay out of the trenches, because we're diving deep into the wonderful world of gangrene and things are about to get soggy.    In an episode that will make you think twice about frolicking through puddles, Kristin is informatively infodumping her hard-earned wisdom regarding your favorite tissue death disorder. From the three types, to the different causes, to what can be done about it, she's covering all things gangrene whether you want it or not.   Also, we're breaking free from the confines of favorite colors, getting into the logistics of our surrogate hugging service, Hugs from Afar, embracing our wet little fronts in a new listener-inspired segment, and letting our gross girl personas shine in Pizza Secrets.  Resources Fournier Gangrene - StatPearls - NCBI Bookshelf (nih.gov) Necrotizing soft tissue infections - UpToDate Gangrene - StatPearls - NCBI Bookshelf (nih.gov)   To keep this horse train running (but this isn't a threat): ko-fi.com/weirdsofafeather Find us on Instagram: @weirdsofafeather  Join our Facebook group: Weirds of a Feather

In this emotionally charged episode of "Pushing Forward with Alycia | A Disability Podcast" Dez Del Barba, a military veteran who became a survivor of medical malpractice after contracting necrotizing fasciitis during his basic training, showcases his unbreakable human spirt and shares his new passion for wheelchair tennis, where he's already won several championships. Dez contracted streptococcus A During his basic training, which, due to misdiagnosis and inadequate treatment, evolved into necrotizing fasciitis. His condition rapidly deteriorated, resulting in the amputation of his left leg above the knee, severe damage to his right leg, underarms, and post-traumatic stress disorder. Dez endured an astonishing 43 surgeries, spent 100 days in the ICU, and underwent months of grueling physical, occupational, and mental health therapy. Despite these unimaginable hardships Dez's story is one of resilience, determination, and triumph. He is not just a survivor; he's a fierce advocate for change within the military healthcare system. His journey from despair to becoming a champion athlete in wheelchair tennis is nothing short of inspirational. Dez's harrowing experience has turned into a mission of giving back through his nonprofit organization, Operation Dez Strong, which provides financial and emotional support to children undergoing amputations. Throughout the episode, we'll also discuss the pressing issue of medical malpractice within the military and the need for legislative changes to ensure accountability and justice for service members. What is necrotizing fasciitis? Necrotizing fasciitis is a rare bacterial infection that spreads quickly in the body and can cause death. This flesh-eating disease occurs when bacteria enter the body through a break in the skin. The condition spreads quickly. Symptoms include blisters, fever, fatigue, and pain worse than a person would expect based on the wound's appearance. Group A strep thought to be most common cause There are many types of bacteria that can cause the “flesh-eating disease” called necrotizing fasciitis. Public health experts believe group A Streptococcus (group A strep) are the most common cause of necrotizing fasciitis. This web page only focuses on necrotizing fasciitis caused by group A strep bacteria. Closing Message: No matter how daunting the challenges, Dez's journey teaches us that resilience, determination, and community support can lead to remarkable transformations. Keep pushing forward, one step at a time, and remember that you are never alone in your journey. Below are links to take urgent action Make a Public Comment demanding that DoD make uniformed service member malpractice victims whole, by removing the caps on damages and all offsets that diminish their benefits as related to their Proposed Rule for Medical Malpractice Claims by Members of the Uniformed Services. Ask your local Congressional Representatives to do the same by December 19th, 2023. Also ask them to support amending the “Feres Doctrine” to include a definition for “Incident to Service,” and request they sign onto passing the “HERO Act” - H.R. 4334. Contact Dez: Read the article from The Army times Personal Story: Read more about Dez's incredible journey of survival. Operation Dez Strong: Discover the nonprofit organization led by Dez and his parents, dedicated to assisting children who have undergone or are undergoing amputations. Instagram: Follow Dez on Instagram for updates on his journey and advocacy. Facebook Page: Stay connected with Dez and his mission on Facebook. ___________________________________________________________________ Connect with Alycia: Feedback | Instagram | LinkedIn | Book Alycia for Speaking | Book Alycia to Train Your Employees in Disabling Ableism | Buy Alycia's DEI Micro Learning Video Series Stay tuned for more inspiring conversations on Pushing Forward with Alycia. Open hearts, clear paths. Let's go.

Episode Notes In this episode, Dr. Angelina Davis talks to us about the use of clindamycin + vancomycin vs. linezolid for the treatment of necrotizing soft tissue infections. The article reviewed in this episode can be found here: https://pubmed.ncbi.nlm.nih.gov/37351452/ For more information about DASON, please visit: https://dason.medicine.duke.edu

Necrotizing enterocolitis, or NEC, is a life-threatening illness with a mortality rate as high as 50% that almost exclusively affects neonates. The complex pathophysiology of NEC is based on an immature intestinal system that makes babies more susceptible to injury once they are fed. Ultimately, this can result in a breakdown of the gut, necrosis and then sepsis and death. There's still no known cure for NEC, but we will discuss the potential of probiotics, specifically lactobacillus reuteri, with our guest Gail Besner, MD. As part of our Women in Medicine series, we are pleased to talk to Dr. Besner, whose research at Nationwide Children's Hospital focuses on identifying novel therapeutic strategies to protect the intestines from intestinal injury, including necrotizing enterocolitis.   Guest:  Gail Besner, MD, is a surgeon-scientist at Nationwide Children's Hospital and The Ohio State University, holds the H. William Clatworthy, Jr. Chair in Surgery, and has been the Chief of Pediatric Surgery at Nationwide Children's Hospital for the past eleven years. She is a member of the Center for Perinatal Research at the Research Institute at Nationwide Children's Hospital. She was the Program Director of the Pediatric Surgery Residency Training Program for many years, and now serves as the Associate Program Director.  She's also a scientific Co-Founder of Scioto Biosciences, Inc., a company designed to bring scientific findings from the laboratory to the bedside.     For more information on Children's Hospital Colorado, visit: childrenscolorado.org  

For the 49th episode on the Empowering NICU Parents' Podcast, we review necrotizing enterocolitis (NEC) which is a life-threatening newborn condition that involves ischemia and inflammation of the bowel. Necrotizing Enterocolitis is a complex disease that despite decades of research, is still not well understood. The evidence continues to support the concurrent presence of several factors that when combined with a trigger, may lead to a disruption of the normal intestinal bacterial flora followed by an altered inflammatory host response. On this episode, you will learn what factors place infants, especially premature infants, at an increased risk to develop NEC. The common clinical symptoms that infants present with once they develop NEC will be reviewed as well as when they are most likely to occur. Additionally, we touch on some of the subtle behavioral changes infants may display at the onset of the disease that are often most obvious to the parents. Next, the diagnostic tests and labs that are typically done once NEC is suspected will be reviewed followed by a description of the Bell staging system which is used to provide a more uniform clinical definition for NEC. The typical management for NEC will also be discussed, followed by a review of some of the common preventative measures that have been put into place in NICUs today to continue to decrease the incidence of NEC. We close out the episode discussing what the prognosis and mortality rate is for infants who have been diagnosed with NEC. The episode is a great overall review of NEC that will be beneficial for NICU parents and clinicians. Start listening now and get ready to be empowered! Our NICU Roadmap: A Comprehensive NICU Journal: https://empoweringnicuparents.com/nicujournal/NICU Mama Hats: https://empoweringnicuparents.com/hats/NICU Milestone Cards: https://empoweringnicuparents.com/nicuproducts/Newborn Holiday Cards: https://empoweringnicuparents.com/shop/Empowering NICU Parents Show Notes: https://empoweringnicuparents.com/shownotes/Episode 49 Show Notes: https://empoweringnicuparents.com/episode49Empowering NICU Parents Instagram: https://www.instagram.com/empoweringnicuparents/Empowering NICU Parents FB Group: https://www.facebook.com/groups/empoweringnicuparentsPinterest Page: https://pin.it/36MJjmH

Pug encephalitis causes inflammation of the brain in some small-breed dogs. It is always fatal and there is no cure. It is estimated that 1.2 percent of Pugs will die from this condition. It is believed to be an inherited autoimmune disorder with genetic markers. Vets may prescribe steroids or other immunosuppressive drugs to manage the condition. Pug dog encephalitis (PDE) is a severe and debilitating disease in small breed dogs that causes inflammation of the brain. This condition is inherited in Pugs but can occur in other breeds as well.    Unfortunately, the disease is fatal and it is estimated that 1.2 percent of Pugs will die from Pug encephalitis (1). Although there is no cure for this disease, early diagnosis and management can help your dog maintain a good quality of life for as long as possible. What is Pug Dog Encephalitis? Pug dog encephalitis is the colloquial name for Necrotizing Meningoencephalitis (NME), a severe and incurable condition that causes inflammation and death of the brain tissue.   Although the disease primarily affects Pugs, other small breed dogs—including Maltese, Chihuahuas, and Yorkshire Terriers, can be affected as well.   Young adults are most commonly affected, with most being diagnosed before 7 years of age. Young, fawn-colored, female Pugs are especially prone to developing this condition. What Causes the Condition? Pug encephalitis is believed to be an inherited autoimmune disorder. In Pugs, genetic markers have been identified that can predict a dog's risk for developing the disease. One in eight Pugs with two copies of these genetic markers will develop Pug encephalitis in their lifetime (2). At this time, it is not known why some dogs develop the disease while others do not. Other small breeds such as Maltese, Chihuahuas, and Yorkshire Terriers can also develop NME. A genetic basis is suspected in these breeds as well, but has not yet been proven. To date, the disease has not been reported in medium or large breed dogs. Symptoms of Pug Dog Encephalitis The symptoms of Pug dog encephalitis may come on gradually or may progress rapidly depending on the patient.  Many cases start with vague symptoms such as lethargy and depression, which can often be overlooked.   As the disease progresses, pet owners may notice more dramatic symptoms, such as: Seizures Collapse Circling Appearing lost or disoriented Behavior changes Weakness, stumbling Blindness Abnormal gait Coma Diagnosing the Condition If your dog is showing symptoms of Pug encephalitis, you should seek veterinary care immediately. Other conditions may present with similar symptoms, so your veterinarian will likely recommend several diagnostic tests to determine the underlying cause of your dog's clinical signs.   Sampling the brain tissue through biopsy or necropsy is the only way to definitively diagnose Necrotizing Meningoencephalitis. However, other less invasive tests may be used to establish a tentative diagnosis.   Your veterinarian will perform a full physical examination, and may perform some or all of the following tests: Blood Work. A complete blood count and biochemistry panel may be performed to evaluate organ function and look for underlying conditions such as liver disease or toxin exposure, which can cause similar clinical signs. Diagnostic Imaging. Imaging such as MRI may be used to evaluate your dog's brain and spinal cord. Often this requires referral to a specialist. Your dog will also likely need to be placed under general anesthesia for this procedure. CSF Tap. Your veterinarian may recommend taking a sample of your dog's cerebrospinal fluid (CSF), which surrounds the brain and spinal cord. Examining the cells of this fluid under a microscope can help rule out other types of meningitis and encephalitis that cause similar clinical signs. Genetic Testing.  In Pugs, a genetic test is available that can identify which individuals are at higher risk for developing NME. Dogs with two copies of the genetic markers of NME are 12.75 times more likely to develop the disease in their lifetime, compared to dogs with only one or no copies of these markers (2). How to Treat Pug Encephalitis Unfortunately, there is no cure for Pug encephalitis. Treatment is focused on decreasing the immune response, alleviating inflammation, and minimizing seizures.   Your veterinarian may prescribe steroids or other immunosuppressive drugs to manage the condition. Antiepileptic drugs may also be prescribed for patients experiencing seizures due to NME.  Most patients will need to stay on these medications for life and will relapse if the medication is discontinued. Because these medications can have severe side effects, some trial and error may be necessary to find the drugs and dosages that work best for your dog. Pug Dog Encephalitis Life Expectancy Pug dog encephalitis is a serious condition and is ultimately fatal. Most dogs will succumb to the disease within a year of diagnosis, although some dogs can survive for several years with medication and supportive care.   Frequent rechecks with your veterinarian will be necessary to monitor response to treatment and ensure your dog is maintaining a good quality of life. Cost to Manage Pug Encephalitis  Pug encephalitis can be costly because it often requires advanced testing to diagnose the condition. In some cases, your dog may need to be referred to a specialist for diagnosis and treatment.   Depending on the medications used, your dog may also need frequent rechecks and blood work to monitor the effects of these drugs.Thus, pet owners should expect to spend several thousand dollars on diagnosis and treatment of Pug dog encephalitis. How to Prevent Pug Dog Encephalitis Studies have shown a strong familial inheritance of this disease in Pugs. The disease is also believed to be genetic in other breeds, although this has not yet been proven. Any dog diagnosed with Pug encephalitis should not be bred, because there is a high risk that the disease will be passed on to the dog's offspring. The parents of affected dogs should also not be bred together again, as they may be carriers of the disease. In Pugs, a genetic test is available which can help identify potential carriers of Pug dog encephalitis. Testing before breeding is recommended to avoid producing puppies with a higher risk of developing this disease. 

Maternal human milk is the absolute best food for newborn nutrition that supports all of their accelerated growth in the first year. And although we have a basic understanding of the composition of human milk, every woman's breast milk has a different complexity when it comes to the nutritional content. But, you may be wondering, what exactly is breast milk composed of? For our 48th podcast episode, I review the general composition of human breast milk and what the variations are between preterm, term, and donor breast milk. I also discuss some of the anti-infective protective properties in maternal breast milk and how a preterm mother's milk has unique and complex properties that are lacking in donor breast milk. I discuss human milk fortification, the different formulations available, and why it is so important in our preterm population. I share why donor breast milk is used in preterm infants over formula and explain its protective mechanisms against necrotizing enterocolitis (NEC). Finally, I discuss how the pasteurization process, although important, impacts the composition of donor breast milk. I share why it is so crucial that mothers feel supported and are educated. Building trusting partnerships with NICU mothers will help to promote their milk expression, establish breastfeeding, and nurture the feelings of motherhood. A supportive environment coupled with education, has the potential to positively impact the mother's milk production in the NICU and beyond. The episode is full of valuable, updated information for both NICU Parents and clinicians, so start listening now, or consider sharing the episode with someone who will gain some value from it! Our NICU Roadmap: A Comprehensive NICU Journal: https://empoweringnicuparents.com/nicujournal/ NICU Mama Hats: https://empoweringnicuparents.com/hats/ NICU Milestone Cards: https://empoweringnicuparents.com/nicuproducts/ Newborn Holiday Cards: https://empoweringnicuparents.com/shop/ Empowering NICU Parents Show Notes: https://empoweringnicuparents.com/shownotes/ Episode 48 Show Notes: https://empoweringnicuparents.com/episode48 Empowering NICU Parents Instagram: https://www.instagram.com/empoweringnicuparents/ Empowering NICU Parents FB Group: https://www.facebook.com/groups/empoweringnicuparents Pinterest Page: https://pin.it/36MJjmH

Thanks for reading this! Please like and share this episode, and also subscribe to the channel. I would greatly appreciate it! Care warning: Necrotizing fasciitis and geekiness exist in this episode. Tim is currently 46 years old and live in Orange County, CA. He was 43 when he contracted NF. He has a many hobbies and interests that include anime, manga, comics, cartoons, Star Wars, some Star Trek, fantasy, cosplay, artist/crafts, music, and sports. He's on Facebook (he can be found through the groups listed below) and Instagram. He's on Instagram as @timunclebear https://www.instagram.com/invites/contact/?i=crd9mnhm3nn9&utm_content=7b0haxa On Facebook he's a member of these NF support groups Necrotizing Fasciitis Survivors https://www.facebook.com/groups/194196200601669/?ref=share Necrotizing Fasciitis Worldwide https://www.facebook.com/groups/necfasc/?ref=share And a sub group "NFW Private" that is found via search or direct invite only. My contact information: www.chrisdtgordon.com @chrisdtgordon Fellow geeks: @nateberan

We are happy to announce that our Christmas merch is now available in our shop, so get you some Cup of Nurses tees, jackets, and sweaters for this holiday season. Or if you're looking for the best gifts for your nurse friends or family, these are perfect.! Check out our shop here https://cupofnurses.shop/

Thanks for reading this! Please like and share this episode, and also subscribe to the channel. I would greatly appreciate it! Care warning: Necrotizing fasciitis and light language exist in this episode. DeAnna Creek is a fellow survivor of necrotizing fasciitis (one of my NF siblings). She discusses how her recent survival not only changed her life, but it also altered her outlook on life. DeAnna's contact information: momomardi@gmail.com My contact information: www.chrisdtgordon.com @chrisdtgordon Lovers of life: @nateberan

Thanks for reading this! Please like and share this episode, and subscribe to the channel. I would greatly appreciate it! Care warning: Necrotizing fasciitis is discussed in this episode. Chris Spath is an NF (necrotizing fasciitis) sibling who not only survived that dreaded disease, but he also used that opportunity to overhaul his life in another remarkable way. His story will inspire you to make necessary changes in your life, too! Instagram: @chrisjspath My contact information: www.chrisdtgordon.com @chrisdtgordon Tech wizards: @nateberan

Thanks for reading this! Please like and share this episode, and subscribe to the channel. I would greatly appreciate it! Care warning: Necrotizing fasciitis is discussed in this episode. Penny is a NF (necrotizing fasciitis) sibling, and she discusses how her life-changing ordeal shifted her mindset. After 28 years in the travel industry, she now helps others fulfill their dreams of business ownership, in the health and wellness arena. With a simple system, that is coupled with a mentor and apprenticeship program, to teach individuals to successfully run a home based business. By working part time, from anywhere, you can add an additional income stream to your portfolio, by working smarter ~ not harder. Penny's contact information: Website: www.pennylyonsjohnston.arbonne.com Facebook: Penny Lyons-Johnston Instagram: @penny.lyons.johnston My contact information: www.chrisdtgordon.com @chrisdtgordon Two fellow world travelers: @nateberan

Dr. Shari Welch discusses various methods to improve ED performance.  From engaging leadership to metrics, Shari gives helpful tips to implement which help with emergency department  efficiency. This episode comes from our Innovations in ED Management  Course. Learn more at https://courses.ccme.org/course/innovationsined

Join our Emergency General Surgery team as they discuss Necrotizing Soft-Tissue Infections. Hosted by Drs. Jordan Nantais, Ashlie Nadler, Stephanie Mason and Graham Skelhorne-Gross. Necrotizing Soft-Tissue Infections: - Also known as “flesh eating disease”, gas gangrene, necrotizing fasciitis/myositis, Fournier's gangrene.  - Early findings are non-specific - Rapidly fatal - diagnostic delay can lead to tremendous additional morbidity and mortality Classification: - Type 1 - polymicrobial category (most common) found in immunosuppressed or elderly - Type 2 - monomicrobial infection [Group A Streptococcus > Methicillin-resistant Staphylococcus aureus (MRSA)] - Type 3 - monomicrobial infection (Vibrio or Clostridium) - Type 4 - fungal (rare) in immunocompromised or after penetration or trauma from candida or Zygomycetes. Initial Workup - History: (comorbidities, immunosuppression, recent infections or trauma) - Exam: swelling, open lesions, drainage, erythema, crepitus, and pain out of proportion      - Most common: swelling, pain, erythema      - Bullae, skin necrosis, crepitus are less common - Labs: Hb, wbc, Na, Creat, glucose, and CRP - Imaging: CT, MRI *sensitive and specific but may not change management - Cut-down: bedside vs in OR - Gm stain  Management - Initially: two large bore IVs, foley catheter, aggressive fluid resuscitation, broad spectrum antibiotics, vasopressors PRN - Abx choices: carbopenem or piperacllin-tazobactam or cefotaxime plus metronidazole. Clindamycin (antitoxin effect) and vancomycin (MRSA) should be considered. - OR: must debride all dead/infected tissue, involve other surgical specialties as needed      - Mark edge of cellulitis and use as initial debridement      - Healthy dermis – pearly and white      - Healthy fat – pale, yellow, glistening      - Healthy fascia – should bleed, doesn't easily separate from muscle      - Healthy muscle – contract with cautery      - Dressing: betadine-soaked gauze on the wound      - Most patients will need at least 3 ORs (second OR generally 8-12 hours after the first)      - No VAC or stoma at first OR References:  1.    Pelletier J, Gottlieb M, Long B, Perkins JC Jr. Necrotizing Soft Tissue Infections (NSTI): Pearls and Pitfalls for the Emergency Clinician. J Emerg Med. 2022 Apr;62(4):480-491. doi: 10.1016/j.jemermed.2021.12.012. Epub 2022 Jan 31.  2.    Sarani B, Strong M, Pascual J, Schwab CW. Necrotizing fasciitis: current concepts and review of the literature. J Am Coll Surg. 2009 Feb;208(2):279-88.  3.    Edlich RF, Cross CL, Dahlstrom JJ, Long WB 3rd. Modern concepts of the diagnosis and treatment of necrotizing fasciitis. J Emerg Med. 2010 Aug;39(2):261-5 4.    Hoesl V, Kempa S, Prantl L, Ochsenbauer K, Hoesl J, Kehrer A, Bosselmann T. The LRINEC Score-An Indicator for the Course and Prognosis of Necrotizing Fasciitis? J Clin Med. 2022 Jun 22;11(13):3583 5.    Bulger EM, May A, Bernard A, Cohn S, Evans DC, Henry S, Quick J, Kobayashi L, Foster K, Duane TM, Sawyer RG, Kellum JA, Maung A, Maislin G, Smith DD, Segalovich I, Dankner W, Shirvan A. Impact and Progression of Organ Dysfunction in Patients with Necrotizing Soft Tissue Infections: A Multicenter Study. Surg Infect (Larchmt). 2015 Dec;16(6):694-701. 6.    LRINEC Score from: https://www.mdcalc.com/calc/1734/lrinec-score-necrotizing-soft-tissue-infection#:~:text=Patients%20were%20classified%20into%20three,%25%20and%20NPV%20of%2096%25. Retrieved July 2022. If you liked this episode, check out our recent episode titled, "Journal Review in Colorectal Surgery: Timing of Biologics and Surgery in the Setting of Crohn's Disease" which can be found here. Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

What is NEC? Necrotizing enterocolitis is a condition that can impact babies born prematurely. The condition can severely impact a baby's intestines. Often, surgical intervention is required. We spoke with Dr. Troy Markel, a Riley pediatric surgeon, about how the surgical team jumps in action to help these patients.

In this episode, Sam Ashoo, MD interviews Kyle Howarth, MD and Joby Thoppil, MD, PhD - two of the authors of the May, 2022 EMP article on Cellulitis and Skin and Soft Tissue Infections. Listen to the discussion to hear more about the emergency department management of cellulitis and necrotizing skin infections. Episode 69 – Emergency Department Management of Cellulitis and Other Skin and Soft-Tissue Infections (https://www.ebmedicine.net/topics/infectious-disease/emergency-medicine-skin) EMplify – May 2022 Episode Outline: 1. Why cellulitis/skin infections? 2. Terminology Erysipelas vs cellulitis vs fasciitis Purulent cellulitis 3. Most common pathogens 4. Special situations 5. Necrotizing infection classification system – is this helpful in the ED, and if so, why? 6. Differential – unilateral vs bilateral presentation 7. Prehospital care 8. ED evaluation History – what should we be asking? Examination: SSTI vs NSTI 9. Diagnostics POCUS: “cobblestoning” and fluid collection Xray: subcutaneous gas CT: when is this helpful? 10. Labs Blood cultures – if given the option, are they helpful?  Wound cultures – any role for these?   Routine labs (CBC, BMP, etc) – are they helpful?  LRINEC score – what is it and should we be using it?  11. Treatment   NSTI antibiotics   Abscesses  12. Special populations  IV drug users  Diabetic patients  Immunocompromised patients  13. Wound irrigation and loop drainage  14. Disposition 

In this episode, Sam Ashoo, MD interviews Kyle Howarth, MD and Joby Thoppil, MD, PhD - two of the authors of the May, 2022 EMP article on Cellulitis and Skin and Soft Tissue Infections. Listen to the discussion to hear more about the emergency department management of cellulitis and necrotizing skin infections. Episode 69 – Emergency Department Management of Cellulitis and Other Skin and Soft-Tissue Infections (https://www.ebmedicine.net/topics/infectious-disease/emergency-medicine-skin) EMplify – May 2022 Episode Outline: 1. Why cellulitis/skin infections? 2. Terminology Erysipelas vs cellulitis vs fasciitis Purulent cellulitis 3. Most common pathogens 4. Special situations 5. Necrotizing infection classification system – is this helpful in the ED, and if so, why? 6. Differential – unilateral vs bilateral presentation 7. Prehospital care 8. ED evaluation History – what should we be asking? Examination: SSTI vs NSTI 9. Diagnostics POCUS: “cobblestoning” and fluid collection Xray: subcutaneous gas CT: when is this helpful? 10. Labs Blood cultures – if given the option, are they helpful?  Wound cultures – any role for these?   Routine labs (CBC, BMP, etc) – are they helpful?  LRINEC score – what is it and should we be using it?  11. Treatment   NSTI antibiotics   Abscesses  12. Special populations  IV drug users  Diabetic patients  Immunocompromised patients  13. Wound irrigation and loop drainage  14. Disposition 

If you are too busy to read the EMEUNET What Is New contributions (https://emeunet.eular.org/what_is_new.cfm), this podcast is exactly for you. Now you can get updated while on the go, with highlights of the most recent publications in the field of Rheumatology, selected for you by EMEUNET members.

What is Science Right?

Welcome to PICU Doc On Call, A Podcast Dedicated to Current and Aspiring Intensivists. I'm Pradip Kamat. I'm Dr. Ali Towne, a rising 3rd-year pediatrics resident interested in a neonatology fellowship, and I'm Rahul Damania and we are coming to you from Children's Healthcare of Atlanta - Emory University School of Medicine. Welcome to our Episode a 5-month-old, ex-28 week female with abdominal distention. Here's the case: A 5-month-old, ex 28 week, female with a past medical history of severe BPD, pulmonary hypertension, home oxygen requirement, and G-tube dependence presents with hypoxemia and increased work of breathing. The patient has a history of prolonged NICU stay with 8 weeks of intubation. The patient developed worsening respiratory distress requiring increased support and eventual intubation for hypoxemic respiratory failure. Echo showed worsened pulmonary hypertension with severe systolic flattening of the ventricular septum and a markedly elevated TR jet. The patient had poor peripheral perfusion, and upon intubation was started on milrinone and epinephrine. The patient improved, but the patient then developed abdominal distention and increasing FiO2 requirements prompting an abdominal x-ray. X-ray showed diffuse pneumatosis with portal venous gas. The patient was made NPO and antibiotic therapy was initiated. To summarize key elements from this case, this patient has NEC. NEC is not a homogenous disease, but rather a collection of diseases with similar phenotypes. Some people split NEC into two categories: Cardiac NEC and Inflammatory NEC. Babies who develop cardiac NEC tend to be significantly older than babies who develop inflammatory NEC (about 1 month vs 2 weeks). There are three main contributory factors to the development of NEC: gut prematurity, abnormal bacterial colonization, and ischemia-reperfusion injury. Many cases result from an ischemic insult to the bowel, resulting in translocation of intra-luminal bacteria into the wall of the bowel, but the etiology and course of NEC can be very variable. This translocation can cause sepsis and death; the ischemia of the bowel can result in intestinal perforation and/or necrosis. Necrotizing enterocolitis (NEC) is one of the most common gastrointestinal emergencies in the newborn infant. It is estimated to occur in 1 to 3 per 1000 live births. More than 90 percent of cases occur in very low birth weight (VLBW) infants (BW

Tis But a Scratch Necrotizing Fasciitis. No matter how you say it. It doesn't sound good. Anytime you hear or see the word Necrotizing, nothing good follows. And the story of Chris DT Gordon surviving Necrotizing Fasciitis isn't that much different. We talk with Chris about his journey - how he got it, how he fought it, and how he survived it. We talk about how Chris is now a podcaster and motivational speaker. Chris hosts a podcast called Scarbearers ( I have been a guest on his show) and talks to people who have overcome, but still bear some scars from what life has dealt them. Come for a story of survival, stick around to be inspired by one of the nicest guys you will ever get a chance to meet. For more information on Chris DT Gordon, please visit the following - www.chrisdtgordon.com Chris DT Gordon - YouTube Channel Scarbearers Audio Podcast on all major podcast providers Please visit Focused on Forward on our Social Media Pages - Twitter - @podcastfof Instagram - @focusedonforward Facebook - Focused on Forward TikTok - the_podcast_guy Support Focused on Forward by contributing to their Tip Jar: https://tips.pinecast.com/jar/focused-on-forward

Necrotizing fasciitis is easily one of the most terrifying and devastating conditions I've ever encountered in my 10+ years as a nurse. In this episode, we go through necrotizing fasciitis using the Straight A Nursing LATTE method. Download the LATTE method template here. Starting nursing school soon? Dial up the confidence and dial down the stress with Crucial Concepts Bootcamp. Michelle says, “I'm preparing to apply for nursing school and am really worried about passing dosage calculations. I signed up for Straight A Nursing Boot Camp and the scenarios for the Dosage Calculations module are HILARIOUS!!! They're not dry and overwhelming like all the other practice problems I've seen. I'm now weirdly excited to learn more about dimensional analysis and for the first time, it has occurred to me that it might be possible to master this concept instead of just white-knuckling through it. Thank you, Nurse Mo!” Read the article and see references here.

In this case of the week radiology lecture, we discuss the imaging appearance of necrotizing pancreatitis on both CT and The post Radiology Case of the Week #5: Necrotizing Pancreatitis appeared first on Radiologist Headquarters.

Proliferative and Necrotizing Otitis Externa (PNOE) is a rare autoimmune disease that can affect young cats. Once you see a picture of this disease, you won't forget it! Learn about the clinical apperance and treatment options available for this crusty disease.

An important recently published randomized control trial provides guidance on this controversy.

On this week's episode of Fast Facts - Perio Edition your host, Katrina Sanders, RDH talks to us about necrotizing periodontal diseases.   Quotes:    “If any of you have ever treated a patient that has a necrotizing periodontal disease, you'll never forget it. In fact, the smell of that disease process alone is probably ingrained into your nose hairs, if you know what I'm talking about.”   “This can also be observed with patients that have an odor, the patients are absolutely experiencing severe inflammation, and I hate to say it, one of my favorite parts about necrotizing disease is that it's oftentimes accompanied by pain, which I think oftentimes is a massive driver.”  Resources:   DentistRX: https://www.dentistrx.com  More Fast Facts: https://www.ataleoftwohygienists.com/fast-facts/    Katrina Sanders Website: https://www.katrinasanders.com  Katrina Sanders Instagram: https://www.instagram.com/thedentalwinegenist/    Sources:   Herrera, D., Retamal‐Valdes, B., Alonso, B., & Feres, M. (2018). Acute periodontal lesions (periodontal abscesses and necrotizing periodontal diseases) and endo‐periodontal lesions. Journal of clinical periodontology, 45, S78-S94.

On this week's episode of Fast Facts - Perio Edition your host, Katrina Sanders, RDH talks to us about necrotizing periodontal diseases.   Quotes:    “If any of you have ever treated a patient that has a necrotizing periodontal disease, you'll never forget it. In fact, the smell of that disease process alone is probably ingrained into your nose hairs, if you know what I'm talking about.”   “This can also be observed with patients that have an odor, the patients are absolutely experiencing severe inflammation, and I hate to say it, one of my favorite parts about necrotizing disease is that it's oftentimes accompanied by pain, which I think oftentimes is a massive driver.”  Resources:   DentistRX: https://www.dentistrx.com  More Fast Facts: https://www.ataleoftwohygienists.com/fast-facts/    Katrina Sanders Website: https://www.katrinasanders.com  Katrina Sanders Instagram: https://www.instagram.com/thedentalwinegenist/    Sources:   Herrera, D., Retamal‐Valdes, B., Alonso, B., & Feres, M. (2018). Acute periodontal lesions (periodontal abscesses and necrotizing periodontal diseases) and endo‐periodontal lesions. Journal of clinical periodontology, 45, S78-S94.

A client starts with a sore throat. Now she's recovering from an infection that required 4 months in the hospital and rehabilitation. She had major surgery, and lost the ends of her fingers and toes in the process. Finally she is home, becoming more active, and wants to receive massage.   How on earth did this happen, and what do we need to know to work safely? It turns out this situation has some eerie links to another issue we hear about every day. Listen in to find out more.     Sponsors:     Anatomy Trains: www.anatomytrains.com      Books of Discovery: www.booksofdiscovery.com       Host Bio:                    Ruth Werner is a former massage therapist, a writer, and an NCBTMB-approved continuing education provider. She wrote A Massage Therapist's Guide to Pathology, now in its seventh edition, which is used in massage schools worldwide. Werner is also a long-time Massage & Bodywork columnist, most notably of the Pathology Perspectives column. Werner is also ABMP's partner on Pocket Pathology, a web-based app and quick reference program that puts key information for nearly 200 common pathologies at your fingertips. Werner's books are available at www.booksofdiscovery.com. And more information about her is available at www.ruthwerner.com.                                     Recent Articles by Ruth:          “Chemotherapy-Induced Peripheral Neuropathy and Massage Therapy,” Massage & Bodywork magazine, September/October 2021, page 33, www.massageandbodyworkdigital.com/i/1402696-september-october-2021/34.           “Pharmacology Basics for Massage Therapists,” Massage & Bodywork magazine, July/August 2021, page 32, www.massageandbodyworkdigital.com/i/1384577-july-august-2021/34.          “Critical Thinking,” Massage & Bodywork magazine, May/June 2021, page 54, www.massageandbodyworkdigital.com/i/1358392-may-june-2021/56.                                 Check out ABMP's Pocket Pathology: www.abmp.com/abmp-pocket-pathology-app                 Resources:   Elsahy, T. G. et al. (2014) “Descending necrotizing mediastinitis,” Saudi Medical Journal 35, no. 9: 1123–6.   Freeman, R. K. et al. (2000) “Descending necrotizing mediastinitis: An analysis of the effects of serial surgical debridement on patient mortality,” Journal of Thoracic and Cardiovascular Surgery 119, no. 2: 260–267. https//doi.org/10.1016/S0022-5223(00)70181-4.   Ochi, N. et al. (2018) “Descending necrotizing mediastinitis in a healthy young adult,” Therapeutics and Clinical Risk Management 14: 2013–17. https://doi.org/10.2147/TCRM.S176520.      About our sponsors:     Anatomy Trains is a global leader in online anatomy education and also provides in-classroom certification programs for structural integration in the US, Canada, Australia, Europe, Japan, and China, as well as fresh-tissue cadaver dissection labs and weekend courses. The work of Anatomy Trains originated with founder Tom Myers, who mapped the human body into 13 myofascial meridians in his original book, currently in its fourth edition and translated into 12 languages. The principles of Anatomy Trains are used by osteopaths, physical therapists, bodyworkers, massage therapists, personal trainers, yoga, Pilates, Gyrotonics, and other body-minded manual therapists and movement professionals. Anatomy Trains inspires these practitioners to work with holistic anatomy in treating system-wide patterns to provide improved client outcomes in terms of structure and function.                       Website: anatomytrains.com                       Email: info@anatomytrains.com                        Facebook: facebook.com/AnatomyTrains                       Instagram: instagram.com/anatomytrainsofficial                       YouTube: www.youtube.com/channel/UC2g6TOEFrX4b-CigknssKHA

Drs. Patrick McGonagill, Lauren Dudas and Carrie Valdez approach the challenge of managing necrotizing pancreatitis in a multidisciplinary discussion with acute care surgeon Dr. Jose Diaz, hepatobiliary and pancreatic surgeon Dr. Clancy Clark and advanced gastroenterologist Dr. Shyam Thakkar.  What are some of the intervention options? How might I approach it at my center? What are the long term complications to look out for?  Hear about it all!

Necrotizing fasciitis took a healthy active 18-year-old and turned him into a double amputee. Blake Haxton was just months away from starting at Ohio State when a pain in his calf turned into a life altering diagnosis. In this episode you'll hear how he fought through the long days and nights to now heading to his second Paralympic Games. You'll also hear his message of hope for the future that helps him continue to get better both mentally and physically. https://www.teamusa.org/para-rowing/athletes/Blake-Haxtonhttps://blakehaxton.com/@stevenalbritton 

Rare. Morbid. Lethal. NSTIs area group of infections which result in aggressive tissue destruction, systemic toxicity, and can involve any layer of the soft tissue. The key to successful management (like so many disease processes) is having a high index of suspicion together with administration of early, broad-spectrum antibiotics and surgery.

Tyler and Jessie talk with Adam Egypt Mortimer, writer/director of SOME KIND OF HATE (2015) HOLIDAYS (2016) DANIEL ISN'T REAL (2019) and ARCHENEMY (2020). Check these out in a hurry if you haven't already! The three chat about empathy in horror films, the trials and triumphs of indie filmmaking, finding creative partners who share your vision, black cats and our new metal band! Necrotizing the Sack featuring our hit single “Bone Dust Asphyxiation.”Have questions for us? Shoot us an email!hollywoodisdeadpodcast@gmail.comFind us on Twitter: @Hwoodisdead_pod or @Archetype_PicsFind us on Instagram: @officialhollywoodisdead or @archetypepictureshttps://archetypepics.com/Catch Adam Egypt Mortimer again on Brandon Legion's The Horrorwolf666 Podcast!Twitter: @horrorwolf666Instagram: @brandonlegion666https://www.horrorwolf666.com/Find Adam Egypt Mortimer here:https://www.adamegyptmortimer.com/https://twitter.com/adamegypt?s=21 https://instagram.com/adamegypt666?igshid=69ibuxovj2r7

Dr. Peter Lio discusses topical steroid addiction – Aplasia cutis congenita – Necrotizing neutrophilic dermatosis – Superficial morphea http://www.dermaspherepodcast.com/ Luke and Michelle report no conflicts of interest

Dr. Diane Birnbaumer breaks down ED cases in which patients present common complaints, initially appearing benign, which mask serious illnesses. This episode comes from our Advanced EM Boot Camp Course which focuses on in-depth topics that will help you become a master practitioner.   Take the Advanced EM Boot Camp course online or live in Las Vegas — both versions are fully CME accredited and are guaranteed to help you provide the best care for your patients.   Learn more at https://courses.ccme.org/course/advancedbootcamp

Erika Hanson

The New Heights Show on Education is an internet radio program in which the hosts cover various topics of education for Home, Charter and Public School families in Ohio and beyond.  Local communities include Paulding, Defiance, Bryan, Van Wert, Delphos, Lima, Putnam County, Wauseon and Napoleon.For an invitation to the live show, visit us on Facebook or Twitter to sign up, or email us at NewHeightsEducation@yahoo.com

It's called the 'flesh-eating bacteria', what what is Necrotizing Faciitis really all about? Today, I look at another deadly disease and break down the facts.

This free iTunes segment is just one tiny snippet of the fully-loaded 3-hour monthly Peds RAP show. Earn CME on your commute while getting the latest practice-changing peds information: journal article breakdowns, evidence-based topic reviews, critical guideline updates, conversations with experts, and so much more. Sign up for the full show at hippoed.com/PEDSRAPPOD. Sol Behar, MD, and Jason Woods, MD discuss the evaluation and management of bilious emesis in a neonate.  Bilious emesis in an infant should be treated as an emergency because this is often a symptom of obstruction due to intestinal atresia or midgut volvulus. Causes of intestinal obstruction that present during the neonatal period include: Malrotation with or without volvulus Intestinal atresia Hirschsprung disease Intussusception (rare in the neonatal period) Necrotizing enterocolitis  Malrotation with volvulus. In this condition, the cecum is abnormally positioned in the right upper quadrant and this abnormal positioning predisposes the intestine to twist on its mesentery resulting in volvulus. This causes acute small bowel obstruction and ischemia.  An upper GI, the gold standard for diagnosing or evaluating malrotation, classically shows a duodenum with a "corkscrew" appearance. Intestinal atresia. This is a term used to describe a complete blockage or obstruction anywhere in the intestine. Approximately 30% of infants with duodenal atresia have a chromosomal anomaly, most typically Down syndrome. The "double bubble" sign is caused by dilation of the stomach and proximal duodenum and strongly suggests duodenal atresia Hirschsprung disease. This is a disorder of the motor innervation of the distal intestine that leads to a functional obstruction. In Hirschsprung, the nerves that allow the relaxation of the smooth muscle within the intestine wall are missing, so the area that is affected is constricted.   A contrast enema can support the diagnosis of Hirschsprung disease. It will often show the presence of a “transition zone” which represents the change from the normal caliber rectum to the dilated colon proximal to the aganglionic region.   For younger kids who have not had time to develop the “transition zone”, the rectosigmoid index, the ratio between the diameter of the rectum and the sigmoid colon, is typically >1 in normal children   Necrotizing enterocolitis. This is a condition characterized by bowel necrosis with associated severe inflammation, bacterial invasion, and dissection of gas into the bowel wall. Pneumatosis intestinalis, a hallmark of NEC, appears as bubbles of gas in the bowel wall. Meconium ileus is caused by the obstruction of the small intestines with inspissated meconium. Approximately 10% of patients with CF present with meconium ileus.

Let's talk about Necrotizing Soft Tissue Infections, including primarily the really scary one - Necrotizing Fasciitis!  This is a topic to constantly keep in the back of your head... to really save some lives.

Sol Behar, MD and Jason Woods, MD get together to discuss the evaluation and management of bilious emesis in a neonate.    Bilious emesis in an infant should be treated as an emergency because this is often a symptom of obstruction due to intestinal atresia or midgut volvulus. Causes of intestinal obstruction that present during the neonatal period include: Malrotation with or without volvulus Intestinal atresia Hirschsprung disease Intussusception (rare in the neonatal period) Necrotizing enterocolitis  To view all the rest of the incredible show notes and see all the  references Click Here 

I discuss Necrotizing fasciitis, or flesh eating bacteria, and how it affected me. I also discuss my mindset, and how that has determined where I am today and where I'll be going in the future. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app

Mastitis: Causes, Prevention and TreatmentDr. Marty Greer joins us for our Veterinary Voice. We’re talking about mastitis in lactating bitches. This infection can come on fast and furious with no warning. In some cases, it can be minor, in others life-threatening. Enjoy an excerpt here: MG: Mastitis is inflammation or infection of the mammary glands, most commonly associated with a female that's nursing her puppies or recently nursing puppies. It can occur occasionally, not very often, associated with a false pregnancy or some other causes. But most commonly we see it in the mom dog that's just had a litter of puppies and for whatever reason there's developed an inflammation or an infection. LR: So what are those common causes? What do you see? Do you see it most frequently when you've just started to wean the litter? Do you see it (while) puppies are nursing? MG: Sometimes it's a litter with a small number of puppies and there's not enough puppies nursing to keep the mammary glands from engorging and becoming infected. Most of the time it's a bacterial infection that just spontaneously happens … you need to keep the whelping box and the area that the female is in really clean to try to prevent it, but I've seen it occur in places where I know that it's impeccably clean. The most common bacteria that we see are either the bacteria in the GI tract or… the ones that we usually see in the bitch’s own environment… so it can just happen that for some reason they send up into the mammary gland. It can be associated with trauma but most of the time it just spontaneously happens. Early mastitis can be a little bit tricky … so we look at every mammary gland. We express the milk out of every gland. Sometimes we’ll have to look at it under the microscope … many times it kind of slaps you in the face, it’s not that hard to see … when you walk in the room and everything was good when she went to bed, you get up the next morning and you see one big red hot swollen gland that's not a diagnostic challenge. It can occur in more than one gland, so it just depends on exactly how it initiates and what the source of the problem is. LR: So, then my next question continuing in the process of we don't really know what causes it do you see this run in families or breeds? Once you've seen it in an individual are you more likely to see it in that individual again? MG: Most of the literature says that it is not a familial or a breed specific trait… Most of the time it's just a one and done. The other thing is that you need to be just really vigilant. I think once you've seen it once you're probably a little bit more hyper vigilant. … mastitis can be very mild or it could be very serious. We can see a form of gangrenous mastitis caused by certain kinds of bacteria that is really, really nasty. Necrotizing mastitis. Fortunately, it's not common. I've had one case of it and I've seen a couple of others from other veterinarians. Those do require surgical excision of the abnormal tissue and in those cases gangrenous really means that the gland or multiple glands will just absolutely turn black and there's a very clear line where the tissue is normal, and the tissue is abnormal. So, it's not particularly difficult surgically to determine where you need to take tissue and where you need to leave it. But those are the only ones that I'll typically take to surgery. Most of the other mastitis cases, even if they tend to abscess open and leave a bit of a tissue gap, I usually don't close those surgically or remove any tissue surgically unless literally that tissue is black. In those cases, yes, surgery has to be done to save the bitch’s life. LR: What other precautions? Do you recommend antibiotics prophylactically? MG: We don't prophylactically use antibiotics on our bitches. What you do, if you do that, is just end up making more resistant bacterial disease if it does develop. Basically, keeping the whelping box clean. Keeping the bitch clean... Support this podcast

“Streptococcus pyogenes” (STREP-TO-COC-CUS PIE-AH-GE-NEEZ) is a bacteriumthat causes “Necrotizing fasciitis” (flesh eating bacteria) which is a serious andprogressive infection that very quickly destroys the skin and soft tissues; musclesand connective tissue that stretches throughout the body. It can cause multiorganfailure and its prognosis largely depends on early diagnosis and immediateaggressive treatment including surgery.This bacterium is found in contaminated waters and takes advantage of a smallwound, scrape or cut of an individual and it begins its process and devours theskin and muscle mass to where it can.Matthew 6:25-34 “25 “Therefore I say to you, do not worry about your life, whatyou will eat or what you will drink; nor about your body, what you will put on. Isnot life more than food and the body more than clothing?26 Look at the birds of the air, for they neither sow nor reap nor gather intobarns; yet your heavenly Father feeds them. Are you not of more value thanthey?27Which of you by worrying can add one cubit to his stature?28 “So why do you worry about clothing? Consider the lilies of the field, how theygrow: they neither toil nor spin;29 and yet I say to you that even Solomon in all his glory was not arrayed like oneof these.30Now if God so clothes the grass of the field, which today is, and tomorrow isthrown into the oven, will He not much more clothe you, O you of little faith?31 “Therefore do not worry, saying, ‘What shall we eat?’ or ‘What shall wedrink?’ or ‘What shall we wear?’32 For after all these things the Gentiles seek. For your heavenly Father knowsthat you need all these things.33 But seek first the kingdom of God and His righteousness, and all these thingsshall be added to you.34 Therefore do not worry about tomorrow, for tomorrow will worry about itsown things. Sufficient for the day is its own trouble.”2Jesus is emphatic in warning us about worry or anxiety because ...• Worry and anxiety is like the bacteria that eats flesh.• Worry or anxiety is dangerous and can even be lethal.• Worry and anxiety must be managed day by dayAnxiety: continuous excessive and intense worries and fears in everydaysituations.Worry and anxiety is a state in which we fall when we want something, needsomething, or think we need something.Jesus our Lord reminds us and teaches that He is very interested in our well-being.I think this word is very appropriate for this difficult and uncertain time formillions of people (maybe you) who not only have to deal with the worry of everyday, but who are or may fall into the mistake of having anxiety and worry for theday of tomorrow.To deal with worry and anxiety Jesus in His Word teaches us or gives us severalguidelines, to avoid being affected by the bacteria of worry and anxiety of futurethings.Support the show (https://www.paypal.com/cgi-bin/webscr?cmd=_s-xclick&hosted_button_id=TU4ST3G79LFDE&source=url)

A troubling case of a painful finger. Resources References Stevens DL, Bryant AE. Necrotizing Soft-Tissue Infections. N Engl J Med. 2017 Dec 7;377(23):2253-2265. Bechar J, Sepehripour S, Hardwicke J, Filobbos G. Laboratory risk indicator for necrotising fasciitis (LRINEC) score for the assessment of early necrotising fasciitis: a systematic review of the literature. Ann R Coll … Continue reading "Episode 1: Necrotizing Soft Tissue Infection"

Necrotizing enterocolitis (NEC) with Aditee Ambardekar

Liza Konnikova, MD, PhD, FAAP, is a neonatologist at UPMC Children's Hospital of Pittsburgh and an assistant professor in the Departments of Pediatrics, Developmental Biology and Immunology in the University of Pittsburgh School of Medicine. Her lab focuses on the develop of neonatal immunity at mucosal surfaces and its role in the pathogenesis of diverse diseases such as sepsis, preterm labor, necrotizing enterocolitis, and very-early onset IBD (VEO-IBD). She has pioneered the application of mass cytometry to frozen mucosal biopsies, helping to improve our understanding of mucosal immunity. This innovation has helped to identify novel populations of immune cells in VEO-IBD and to perform serial monitoring of IBD activity during drug trials.

Join us for our 7th joint Journal Club with Annals of Surgery. This time our guest is Dr. Chad Ball, a hepatobiliary and acute care surgeon and Associate Professor at the University of Calgary.    He has pioneered a new single-stage approach for walled off pancreatic necrosis, "surgical transgastric necrosectomy," described in this Annals paper:  https://journals.lww.com/annalsofsurgery/Abstract/publishahead/Surgical_Transgastric_Necrosectomy_for_Necrotizing.95399.aspx    Join us to learn more the range of approaches to this challenging problem and new, exciting techniques!   PS: For those interested, a video of laparoscopic transgastric necrosectomy can be found here: https://www.youtube.com/watch?v=VWPiaZpzAxQ  

Michael Morowitz, MD, is an associate professor of Surgery and an attending physician in the Division of Pediatric and General Thoracic Surgery. Dr. Morowitz’s research focuses on Necrotizing Enterocolitis (NEC), a mysterious disorder of intestinal inflammation in premature newborn infants. His lab studies the microbiome, the vast collection of microorganisms that cover our bodies, inside and out.

Nadz no call no show. Mama Nadz calls in and fights with Duji. Nadz calls in and says he's going to the hospital. New Zealand shooter kills 49 people.

When an infant is born, their first introduction is to a new immune system and new bacteria. Tim Hand, PhD, assistant professor with the Richard King Mellon Foundation Institute for Pediatric Research, takes samples from the neonatal intensive care unit (NICU) at UPMC Magee-Womens Hospital, to look at how antibodies in a mother’s breast milk may shape the relationship between an infant and their microbiome. Listen in as Dr. Hand discusses the unique microbiome of premature infants, necrotizing enterocolitis (NEC), and how maternal IgA, an active component in a mother’s breast milk, can shape a child’s immune system.

Finishing up sophomore year at Seton Hall University in New Jersey,  Kainoa Spenser was about to face the fight of his life. The International Affairs major woke up one day not feeling well.  The next day he passed out.  Believing that he was just exhausted from finals, Spenser tried to power through. He flew home to Arizona and was immediately rushed to HonorHealth.  His organs were failing. He explains that he was transferred to Mayo Hospital where doctors put Spenser into a medically induced coma.  Necrotizing fasciitis, a flesh-eating disease, ended up leading to the amputation of Spenser's legs and hands. “When I got out of the hospital a little over a year ago I was connected immediately with Kyle Maynard. He was born with congenital amputations.  Seeing how he was able to transform that tragedy into something that is inspiring to all, and has radically improved his life and lives around the world, was cool to see.  How he was able to turn his pain into … purpose,” Spenser explains. On our Carey Pena Reports Podcast, Spenser told his story alongside his Trainer and Coach, Jesse Holland.  The two met after Spenser spoke at an event for K2 Adventures, for which Holland is a Mountain Guide. They began to chart a course for Spenser's recovery.  “Kainoa often shows me and everybody what we can do.  That we are not a victim,” Holland says. The first objective for Kainoa was to get back to holding a golf club and to have enough stamina to be able to swing. He met and surpassed that goal over the past year, having golfed in two tournaments. Now, Kainoa Spenser is joining K2 Adventures and Jesse Holland on a trip to Mount Kosciuszko, Australia's highest mountain. It's located on the Main Range of the Snowy Mountains in Kosciuszko National Park, part of the Australian Alps National Parks and Reserves. “Improving your mental health starts with improving your physical health,” Spenser says of his ongoing recovery and the lofty physical goals he has set for himself. All along, the community has rallied around Kainoa Spenser and his family using the hashtag #LiveLikeKainoa While he has had overwhelming support, there have been many dark days. And he allows himself the mental space to be depressed – with an end date. “Nothing is wrong with having those (dark days), but the best part is knowing that it's going to end. And setting the end date,” Spenser explains. “You can feel bad for yourself, and eat the worst food for yourself, and watch all the movies you want, and sit on the couch, but know on Monday when you wake up, that that's the end and you are moving forward.” Kainoa serves as inspiration to the Arizona community where he now lives and to the Seton Hall community in New Jersey where he previously went to school, but also for people all over the world who have discovered his story. Around his neck, Kainoa Spenser wears a Tree of Life Intention Stick, created by Valley residents Scott and Marla Berger. Inside the necklace, Spenser puts his words of intention and that's where he keeps his focus. Also, he has his faith. “I have a major connection with God,” Spenser shares. “And he allows me, and my faith truly allows me to have that first breath of … it's going to be okay. There's something greater for this purpose and you have to find those motivating factors outside of yourself.” https://k2adventures.org/ http://kyle-maynard.com/ https://yourscottsdalecoach.com/ The post College Student Climbs One Of The 7 Summits After Loss of Limbs appeared first on Inspired Media 360 TV - Inform | Inspire | Engage.

Dr. Mitch Goldstein explains what NEC is, who it typically affects, its symptoms, and treatment. He also discusses what parents should ask about their baby's nutrition in the NICU. Kelli then speaks to Stephanie Vaughan whose son contracted NEC while in the NICU. Stephanie speaks about his journey back to health and how she eventually started The Morgan Leary Vaughan Fund to educate other parents about NEC.

Dr. Mitch Goldstein explains what NEC is, who it typically affects, its symptoms, and treatment. He also discusses what parents should ask about their baby's nutrition in the NICU. Kelli then speaks to Stephanie Vaughan whose son contracted NEC while in the NICU. Stephanie speaks about his journey back to health and how she eventually started The Morgan Leary Vaughan Fund to educate other parents about NEC.

Author: Peter Bakes, MD Educational Pearls:   Necrotizing fasciitis is an infection of the deep soft tissues with destruction of the muscle fascia and overlying fat Think of it if pain is out of proportion to your exam Polymicrobial and Clostridium species typically cause condition in susceptible individuals (immunocompromised, diabetics, obese, penetrating injury) Group A strep typically is less specific and can cause necrotizing infections in otherwise healthy individuals Treatment is typically rapid surgical debridement in addition to broad spectrum antibiotics in addition to clindamycin   References: Breyre A, Frazee BW. Skin and Soft Tissue Infections in the Emergency Department. Emerg Med Clin North Am. 2018 Nov;36(4):723-750. doi: 10.1016/j.emc.2018.06.005. Review. PubMed PMID: 30297001. Stevens DL, Bryant AE. Necrotizing Soft-Tissue Infections. N Engl J Med. 2017 Dec 7;377(23):2253-2265. doi: 10.1056/NEJMra1600673. Review. PubMed PMID: 29211672.   Summary by Travis Barlock, MS4  | Edited by Erik Verzemnieks, MD

This is a discussion with Dr. Kenneth Bernard, an emergency physician working on a Native American reservation in Arizona. We discuss the First Annual Native America and Rural Emergency Medicine Conference. We also discuss a case of necrotizing fasciitis and a minimally invasive procedure that can aid in the diagnosis of this condition.

This weekend discuss two articles from the most recent Journal of Oral & Maxillofacial Surgery and the first one is on the risk factors affecting the prognosis of descending necrotizing mediastinitis from a dental infection the second article that I discuss is a discussion about the development of the Dual degree program in oral maxillofacial surgery

Abdominal pain is common; so are strongly held myths and legends about what is concerning, and what is not.   One of our largest responsibilities in the Emergency Department is sorting out benign from surgical or medical causes of abdominal pain.  Morbidity and mortality varies by age and condition.   Abdominal Surgical Emergencies in Children: A Relative Timeline General Advice Neonate (birth to one month) Necrotizing Enterocolitis Pneumatosis Intestinalis. Essentials: Typically presents in 1st week of life (case reports to 6 months in chronically ill children) Extend suspicion longer in NICU graduates Up to 10% of all cases of necrotizing enterocolitis are in full-term children Pathophysiology is unknown, but likely a translocation of bacteria Diagnosis: Feeding intolerance, abdominal distention Abdominal XR: pneumatosis intestinalis Management: IV access, NG tube, broad-spectrum antibiotics, surgery consult, ICU admission Intestinal Malrotation with Volvulus Essentials: Corkscrew Sign in Malrotation with Volvulus Bilious vomiting (80-100%) in the 1st month; especially in the 1st week May look well initially, then rapidly present in shock Ladd’s bands: abnormally high tethering of cecum to abdominal wall; peristalsis, volvulus, ischemia Diagnosis: History of bilious emesis is sufficient to involve surgeons Upper GI series: corkscrew appearance US (if ordered) may show abnormal orientation of and/or flow to superior mesenteric artery and vein Management: Stat surgical consult IV access, resuscitation, NG tube to decompress (bowel wall perfusion at risk, distention worsens) Hirschprung Disease Essentials: Problem in migration of neural crest cells Aganglionic colon (80% rectosigmoid; 15-20% proximal to sigmoid; 5% total colonic aganglionosis) colon (known as short-segment disease) Poor to no peristalsis: constipation, perforation, and/or sepsis Diagnosis: May be diagnosed early as “failure to pass meconium in 1st 48 hours” In ED, presents as either bowel obstruction or enterocolitis Contrast enema Beware of the toxic megacolon (vomiting, distention, sepsis) Management: Resuscitation, antibiotics, NG tube decompression, surgical consultation; stable patients may need rectal biopsy for confirmation Staged surgery (abdominoperineal pull-through with diverting colostomy, subsequent anastomosis) versus one-stage repair. Infant and Toddler (1 month to 2 years) Pyloric Stenosis Essentials: Hypertrophy of pyloric sphincter; genetic, environmental, exposure factorsString Sign in Pyloric Stenosis. Diagnosis: Hungry, hungry, not-so-hippos; they want to eat all of the time, but cannot keep things down Poor weight gain (less than 20-30 g/day) US: “π–loric stenosis” (3.14); pylorus dimensions > 3 mm x 14 mm UGI: “string sign” Management: Trial of medical treatment with oral atropine via NGT (muscarinic effects decrease pyloric tone) Ramstedt pyloromyotomy (definitive) Intussusception Essentials: Majority (90%) ileocolic; no pathological lead point Small minority (4%) ileoileocolic due to lead point: Meckel’s diverticulum, polyp, Peyer’s patches, Henoch-Schönlein purpura (intestinal hematoma) Diagnosis: Target Sign (Donut Sign). Ultrasound sensitivity and specificity near 100% in experienced hands Abdominal XR may show non-specific signs; used mainly to screen for perforation before reduction Management: Hydrostatic enema: contrast (barium or water-soluble contrast with fluoroscopy) or saline (with ultrasound) Air-contrast enema: air or carbon dioxide (with either fluoroscopy or ultrasound); higher risk for perforation than hydrostatic (1% risk), but generally safer than perforation from contrast Consider involving surgical service early (precaution before reduction) Traditional disposition is admission; controversial: home discharge from ED Young Child and Older (2 years and up) Appendicitis Essentials: Appendicitis occurs in all ages, but rarer in infants. Infants do not have fecalith; rather they have some other anatomic or congenital condition.  More common in school-aged children (5-12 years) and adolescents Younger children present atypically, more likely to have perforated when diagnosed. Diagnosis: Non-specific signs and symptoms Often have abdominal pain first; vomiting comes later Location/orientation of appendix varies Appendicitis scores vary in their performance Respect fever and abdominal pain   Management: Traditional: surgical On the horizon: identification of low-risk children who may benefit from trial of antibiotics If perforated, interval appendectomy (IV antibiotics via PICC for 4-6 weeks, then surgery) Obstruction SBO. Incarcerated Inguinal Hernia. Essentials: Same pathophysiology and epidemiology as adults: “ABC” – adhesions, “bulges” (hernias), and cancer. Diagnosis: Obstruction is a sign of another condition. Look for cause of obstruction: surgical versus medical Abdominal XR in low pre-test probability CT abdomen/pelvis for moderate-to-high risk; confirmation and/or surgical planning Management: Treat underlying cause NG tube to low intermittent wall suction Admission, fluid management, serial examinations   Take these pearls home: Consider surgical pathology early in encounter Resuscitate while you investigate Have a low threshold for imaging and/or consultation, especially in preverbal children   Selected References Necrotizing Enterocolitis Neu J, Walker A. Necrotizing Enterocolitis. N Eng J Med. 2011; 364(3):255-264. Niño DF et al. Necrotizing enterocolitis: new insights into pathogenesis and mechanisms. Nature. 2016; 13:590-600. Walsh MC et al. Necrotizing Enterocolitis: A Practitioner’s Perspective. Pediatr Rev. 1988; 9(7):219-226. Malrotation with Midgut Volvulus Applegate KE. Intestinal Malrotation in Children: A Problem-Solving Approach to the Upper Gastrointestinal Series. Radiographics. 2006; 26:1485-1500. Kapfer SA, Rappold JF. Intestinal Malrotation – Not Just the Pediatric Surgeon’s Problem. J Am Coll Surg. 2004; 199(4):628-635. Lee HC et al. Intestinal Malrotation and Catastrophic Volvulus in Infancy. J Emerg Med. 2012; 43(1):49-51. Martin V, Shaw-Smith C. Review of genetic factors in intestinal malrotation. Pediatr Surg Int. 2010; 26:769-781. Nehra D, Goldstein AM. Intestinal malrotation: Varied clinical presentation from infancy through adulthood. Surgery. 2010; 149(3):386-391. Hirschprung Disease Amiel J, Sproat-Emison E, Garcia-Barcelo M, et al. Hirschsprung disease, associated syndromes and genetics: a review. J Med Genet 2008; 45:1. Arshad A, Powell C, Tighe MP. Hirschsprung's disease. BMJ 2012; 345:e5521. Aworanti OM, McDowell DT, Martin IM, Quinn F. Does Functional Outcome Improve with Time Postsurgery for Hirschsprung Disease? Eur J Pediatr Surg 2016; 26:192. Clark DA. Times of first void and first stool in 500 newborns. Pediatrics 1977; 60:457. Dasgupta R, Langer JC. Evaluation and management of persistent problems after surgery for Hirschsprung disease in a child. J Pediatr Gastroenterol Nutr 2008; 46:13. De Lorijn F, Reitsma JB, Voskuijl WP, et al. Diagnosis of Hirschsprung's disease: a prospective, comparative accuracy study of common tests. J Pediatr 2005; 146:787. Doig CM. Hirschsprung's disease and mimicking conditions. Dig Dis 1994; 12:106. Khan AR, Vujanic GM, Huddart S. The constipated child: how likely is Hirschsprung's disease? Pediatr Surg Int 2003; 19:439. Singh SJ, Croaker GD, Manglick P, et al. Hirschsprung's disease: the Australian Paediatric Surveillance Unit's experience. Pediatr Surg Int 2003; 19:247. Suita S, Taguchi T, Ieiri S, Nakatsuji T. Hirschsprung's disease in Japan: analysis of 3852 patients based on a nationwide survey in 30 years. J Pediatr Surg 2005; 40:197. Sulkowski JP, Cooper JN, Congeni A, et al. Single-stage versus multi-stage pull-through for Hirschsprung's disease: practice trends and outcomes in infants. J Pediatr Surg 2014; 49:1619. Pyloric Stenosis Aspelund G, Langer JC. Current management of hypertrophic pyloric stenosis. Semin Pedaitr Surg. 2007; 16:27-33. Dias SC et al. Hypertrophic pyloric stenosis: tips and tricks for ultrasound diagnosis. Insights Imaging. 2012; 3:247-250. Kawahara H et al. Medical treatment of infantile hypertrophic pyloric stenosis: should we always slice the olive? J Pediatr Surg. 2005; 40:1848-1851. Mack HC. Adult Hypertrophic Pyloric Stenosis. Arch Inter Med. 1959; 104:78-83. Meissner PE et al. Conservative treatment of infantile hypertrophic pyloric stenosis with intravenous atropine sulfate does not replace pyloromyotomy. Pediatr Surg Int. 2006; 22:1021-1024. Mercer AE, Phillips R. Can a conservative approach to the treatment of hypertrophic pyloric stenosis with atropine be considered a real alternative to pyloromyotomy? Arch Dis Child. 2013; 95(6): 474-477. Pandya S, Heiss K, Pyloric Stenosis in Pediatric Surgery.Surg Clin N Am. 2012; 92:527-39. Peters B et al. Advances in infantile hypertrophic pyloric stenosis. Expert Rev Gastroenterol Hepatol. 2014; 8(5):533-541. Intussusception Apelt N et al. Laparoscopic treatment of intussusception in children: A systematic review. J Pediatr Surg. 2013; 48:1789-1793. Applegate KE. Intussusception in Children: Imaging Choices. Semin Roentgenol. 2008; 15-21. Bartocci M et al. Intussusception in childhood: role of sonography on diagnosis and treatment. J Ultrasound. 2015; 18 Gilmore AW et al. Management of childhood intussusception after reductiion by enema. Am J Emerg Med. 2011; 29:1136-1140.:205-211. Chien M et al. Management of the child after enema-reduced intussusception: hospital or home? J Emerg Med. 2013; 44(1):53-57. Cochran AA et al. Intussusception in traditional pediatric, nontraditional pediatric, and adult patients. Am J Emerg Med. 2011; 523-527. Loukas M et al. Intussusception: An Anatomical Perspective With Review of the Literature. Clin Anatomy. 2011; 24: 552-561. Mendez D et al. The diagnostic accuracy of an abdominal radiograph with signs and symptoms of intussusception. Am J Emerg Med. 2012; 30:426-431. Whitehouse et al. Is it safe to discharge intussusception patients after successful hydrostatic reduction? J Pediatr Surg. 2010; 45:1182-1186. Appendicitis Amin P, Chang D. Management of Complicated Appendicitis in the Pediatrc Population: When Surgery Doesn’t Cut it. Semin Intervent Radiol. 2012; 29:231-236 Blakely ML et al. Early vs Interval Appendectomy for Children With Perforated Appendicitis. Arch Surg. 2011; 146(6):660-665. Bundy DG et al. Does This Child Have Appendicitis? JAMA. 2007; 298(4):438-451. Cohen B et al. The non-diagnostic ultrasound in appendicitis: is a non-visualized appendix the same as a negative study? J Pediatr Surg. 2015 Jun;50(6):923-7 Herliczek TW et al. Utility of MRI After Inconclusive Ultrasound in Pediatric Patients with Suspected Appendicitis. AJT. 2013; 200:969-973. Janitz et al. Ultrasound Evaluation for Appendicitis. J Am Osteopath Coll Radiol. 2016; 5(1):5-12. Kanona H et al. Stump Appendicitis: A Review. Int J Surg. 2012; 10:4255-428. Kao LS et al. Antibiotics vs Appendectomy for Uncomplicated Acute Appendicitis. Evid Based Rev Surg. 2013;216(3):501-505. Petroianu A. Diagnosis of acute appendicitis. Int J Surg. 2012; 10:115-119. Mazeh H et al. Tip appendicitis: clinical implications and management. Amer J Surg. 2009; 197:211-215. Puig S et al. Imaging of Appendicitis in Children and Adolescents. Semin Roentgenol. 2008; 22-28. Schizas AMP, Williams AB. Management of complex appendicitis. Surgery. 2010; 28(11):544-548. Shogilev DJ et al. Diagnosing Appendicitis: Evidence-Based Review. West J Emerg Med. 2014; 15(4):859-871. Wray CJ et al. Acute Appendicitis: Controversies in Diagnosis and Management. Current Problems in Surgery. 2013; 50:54-86 Intestinal Obstruction Babl FE et al. Does nebulized lidocaine reduce the pain and distress of nasogastric tube insertion in young children? A randomized, double-blind, placebo-controlled trial. Pediatrics. 2009 Jun;123(6):1548-55 Chinn WM, Zavala DC, Ambre J. Plasma levels of lidocaine following nebulized aerosol administration. Chest 1977;71(3):346-8. Cullen L et al. Nebulized lidocaine decreases the discomfort of nasogastric tube insertion: a randomized, double-blind trial. Ann Emerg Med. 2004 Aug;44(2):131-7. Gangopadhyay AN, Wardhan H. Intestinal obstruction in children in India. Pediatr Surg Int. 1989; 4:84-87. Hajivassiliou CA. Intestinal Obstruction in Neonatal/Pediatric Surgery. Semin Pediatr Surg. 2003; 12(4):241-253. Hazra NK et al. Acute Intestinal Obstruction in children: Experience in a Tertiary Care Hospital. Am J Pub Health Res. 2015; 3(5):53-56. Kuo YW et al. Reducing the pain of nasogastric tube intubation with nebulized and atomized lidocaine: a systematic review and meta-analysis. J Pain Symptom Manage. 2010 Oct;40(4):613-20.  . Pediatric Surgery Irish MS et al. The Approach to Common Abdominal Diagnoses in Infants and Children. Pedaitr Clin N Am. 1998; 45(4):729-770. Louie JP. Essential Diagnosis of Abdominal Emergencies in the First Year of Life. Emerg Med Clin N Am. 2007; 25:1009-1040. McCullough M, Sharieff GQ. Abdominal surgical emergencies in infants and young children. Emerg Med Clin N Am. 2003; 21:909-935. Pepper VK et al. Diagnosis and Management of Pediatric Appendicitis, Intussusception, and Meckel Diverticulum. Surg Clin N Am. 2012   This post and podcast are dedicated to Mr Ross Fisher for his passion and spirit of collaboration in all things #FOAMed.  Thank you, sir!

In this episode Dr. Smith speaks with Dr. Jeff Suh. They will discuss the article: Aggressive Necrotizing Pseudomonal Sinonasal infections. Read the article in International Forum of Allergy and Rhinology Listen and subscribe for free on Apple Podcasts, Google Play Music and Subscribe on Android

Join us for an in depth discussion of NSTI with Dr. Eileen Bulger, MD, Professor of Surgery at the University of Washington and Chief of Trauma Surgery for Harborview Medical Center and Dr. Rondi Gelbard, MD, upcoming NSTI PMG Team Leader and Assistant Professor of Surgery at Emory University.   We discuss the timing of debridement, antibiotic management, role for transfer, HBO and so much more!   Moderated by Drs. Carrie Valdez and Dave Morris

Welcome to HBOT in Wound Care Episode 5: Reperfusion Injury Click Here to Download Audio  

Welcome to HBOT in Wound Care Episode 4: Oxygen Epigenetics Click Here to Download Audio Hyperbaric oxygen therapy has been a misunderstood therapy for over 300 years. As a wound care treatment that simply uses oxygen in a pressurized chamber it was clear that HBOT makes wounds heal faster, and that’s it. Many people have … Continue reading "Episode 4: Oxygen Epigenetics"

Welcome to HBOT in Wound Care Episode 3: Traumatic Brain Injury Treatment Click to download audio file: In this episode Dr. Harch tells us that “hyperbaric oxygen therapy is a treatment for wounds in the body at any location and for any duration.” Doctor Harch talks exclusively about treating wounds in the brain. Treatment for … Continue reading "Episode 3: Traumatic Brain Injury Treatment"

Welcome to HBOT in Wound Care Episode 2: Hyperbaric Oxygen Effect on the Inflammation Reaction Right click to download audio file: On HBOT-in-Wound Care join Dr. Paul Harch and myself as we create and publish this podcast series to bring awareness of how Hyperbaric Oxygen treatment aids the body’s growth and repair systems. Dr. Harch … Continue reading "Episode 2: Hyperbaric Oxygen Effect on the Inflammation Reaction"

Megan Sanctuary, MS, PhD candidate, is a student at the University of California, Davis. She is a member of the Milk Group that has been decoding mother’s milk for clues to lasting health for the past decade. She is currently using this basic science information to develop effective clinical interventions. A feature of the evolution of lactation is the explicit development of a symbiotic relationship between microbes and the mammalian host. This relationship is emerging as a key process of proper development. Human milk feeds and guides the colonization of the infant gut microbiota and nourishes the phenotypic state and metabolic processes of bacteria evolved to this unusual ecological niche. A milk-oriented microbiota (MOM) sets the infant up for a lifetime of health. The crosstalk between maternal milk and the infant gut has been the focus of research of an interdisciplinary and highly integrated team, the Milk Group, at UC Davis, for the past decade. Megan's group have used the insights gained from basic science research to steer the development of clinical solutions. Interestingly, one of the most abundant components of human milk, oligosaccharides, provides no direct nutritional support to the infant. Instead, they have shown that these complex sugars actually selectively promote the growth of beneficial bacteria in the gut while excluding potential pathogens. The specificity of this interaction is a key principle to understanding how the microbial ecology of the intestine goes wrong promoting conditions like irritable bowel syndrome in adults and necrotizing enterocolitis in preterm infants. This paradigm has been utilized in recent clinical trials with success, and we have also began to examine the gut microbiota-brain axis in neurodevelopmental disorders such as autism. [00:03:32] Milk-oriented microbiota presentation at AHS 16. [00:06:15] Implications for the microbiota. [00:06:58] Critical periods of development. [00:08:34] The functions of the microbiota. [00:08:54] Oligosaccharides in milk are prebiotics for bacteria. [00:10:16] Immune factors in milk, lactoferrin. [00:12:56] "Lock and key" milk specificity. [00:15:07] Donor milk. [00:16:24] There is no substitute for human breast milk. [00:17:55] Pasteurisation. [00:19:06] WAPF milk formulations. [00:22:57] Should we be consuming the milk of other animals? [00:24:36] Raw dairy from a cow that you know. [00:27:31] Other hormones in milk. [00:27:50] Type 1 diabetes. [00:29:19] Gut health could be the deciding factor. [00:31:53] Necrotizing enterocolitis. [00:32:34] Bifidobacteria supplementation (probiotics). [00:33:35] Autism and antibiotics. [00:35:03] Neurotransmitters and short-chain fatty acids. [00:37:06] Environmental toxicity. [00:41:54] Megan is consulting, email her.

Puncture Wound A wound that is deep but a small point of entry (i.e. nail).   This allows the bacteria to get stuck inside.  Thus it won't always bleed cuz the opening is too small for it to make it out.   So if the blood can't get out, then antibiotic ointments can't get in. Signs of Infection Swelling Redness Pain Warm "Lumpy" or "Dimpled" Oozing "Running" or "crawling" veins Lockjaw anyone?  Tetanus is an opportunistic infection that gets into the body from dirty objects and then causes muscle rigidity (among other things).  It is very easy to prevent with a booster shot. Cellulitis is not the same as cellulite, but does affect the same layer of the skin! It's an infection caused by the normal bacteria that live on your skin.  As long as it's on your skin - cool, we're friends.  If it gets in your skin - that's trouble.  Staph or strep - friends on the outside, enemies on the inside.  Requires oral antibiotics, and sometimes, even IV antibiotics. Necrotizing fasciitis - bacterial infection gets so deep into the skin layers that it starts eating away the dermis and muscles below it. Risks for Cellulitis surgical sites cuts and abrasions puncture wounds!!!! skin ulcers (from prosthetics, wheelchairs, or being bedridden) spider and insect bites (bugs aren't sterile, plus toxins - ick!) cracked dry skin hangnails athlete's foot (skin changes, including cracking) Takeaway Puncture wounds should not be treated at home - especially if you were stuck by something dirty. Connect with me Support us on Patreon *NEW* Join the Pharmacist Answers Podcast Community on Facebook Subscribe: iTunes, Stitcher, GooglePlay, TuneIn Radio Like the Facebook page Music Credits:  "Radio Martini" Kevin MacLeod (incompetech.com)  Licensed under Creative Commons: By Attribution 3.0  http://creativecommons.org/licenses/by/3.0/ "Fluffing a Duck" Kevin MacLeod (incompetech.com) Licensed under Creative Commons: By Attribution 3.0 http://creativecommons.org/licenses/by/3.0/

We review the post by Bryan Hayes, PharmD, FAACT on Academic Life in Emergency Medicine,  Sulfamethoxazole-Trimethoprim for Skin and Soft Tissue Infections: 1 or 2 Tablets BID?  Then, we delve into core content pearls on cellulitis and abscesses, necrotizing skin infections, and Erythema Multiforme/Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis using the IDSA guidelines, Tintinalli, and Rosen's as a guide.  As always, visit foamcast.org for show notes and the generously donated Rosh Review questions. Thanks y'all! -Jeremy Faust and Lauren Westafer

Necrotizing Myopathies by Dr. Andrew L. Mammen. This is part one of a three part series on immune-mediated myopathies and autoantibodies.

Necrotizing Myopathies by Dr. Andrew L. Mammen. This is part one of a three part series on immune-mediated myopathies and autoantibodies.

Necrotizing Myopathies by Dr. Andrew L. Mammen. This is part one of a three part series on immune-mediated myopathies and autoantibodies.

Necrotizing fasciitis is a bacterial infection that can spread rapidly throughout your body and destroy its soft tissue.Necrotizing fasciitis, also known as the "flesh-eating disease," is a bacterial infection that can spread rapidly throughout your body and destroy its soft tissue.According to the National Necrotizing Fasciitis Foundation, the bacterium that causes necrotizing fasciitis is within the group A Strep bacteria, the same bacteria that can cause strep throat.With just a cut, burn or bump to your skin, bacteria enters your body and can cause this flesh-eating disease. Depending on how moderate the case, you can be treated with heavy antibiotics.However, delaying care can cause the disease to worsen, allowing the toxins from the disease to destroy the tissue it infects. As a result, your tissues start to die.Even though your chances of getting this disease are very slim, it's important to recognize the symptoms and what could be posing serious health threats to you or a loved one.NeutroPhase is the newest treatment for necrotizing fasciitis. It contains Hypochlorous acid, a natural substance, which, when produced in the body's immune system, serves as a first defense against microbial invaders.How does this treatment differ from other alternative treatments?John Crew, MD, joins Melanie Cole, MS, to discuss what necrotizing fasciitis is, the symptoms of the disease and the newest treatment options available.

Necrotizing fasciitis is a bacterial infection that can spread rapidly throughout your body and destroy its soft tissue.Necrotizing fasciitis, also known as the "flesh-eating disease," is a bacterial infection that can spread rapidly throughout your body and destroy its soft tissue.According to the National Necrotizing Fasciitis Foundation, the bacterium that causes necrotizing fasciitis is within the group A Strep bacteria, the same bacteria that can cause strep throat.With just a cut, burn or bump to your skin, bacteria enters your body and can cause this flesh-eating disease. Depending on how moderate the case, you can be treated with heavy antibiotics.However, delaying care can cause the disease to worsen, allowing the toxins from the disease to destroy the tissue it infects. As a result, your tissues start to die.Even though your chances of getting this disease are very slim, it's important to recognize the symptoms and what could be posing serious health threats to you or a loved one.NeutroPhase is the newest treatment for necrotizing fasciitis. It contains Hypochlorous acid, a natural substance, which, when produced in the body's immune system, serves as a first defense against microbial invaders.How does this treatment differ from other alternative treatments?John Crew, MD, joins Melanie Cole, MS, to discuss what necrotizing fasciitis is, the symptoms of the disease and the newest treatment options available.

Vincent, Michael, and Elio review necrotizing fasciitis, and a link between surface remodeling in gram-positive and gram-negative bacteria.

1) A case of Necrotizing myopathy 2) Topic of the month: Diagnosis of MCI and AD. This podcast for the Neurology Journal begins and closes with Dr. Robert Gross, Editor-in-Chief, briefly discussing highlighted articles from the print issue of Neurology. In the second segment Dr. Andy Mammen interviews Prof. Michael Hanna about his paper on necrotizing myopathy. Dr. Jennifer Fugate is reading our e-Pearl of the week about unilateral clubbing in hemiplegia. In the next part of the podcast Dr. Jeff Burns interviews Dr. John Morris about clinical diagnosis of Alzheimer disease. Over the upcoming weeks they will discuss a number of topics related to mild cognitive impairment and Alzheimer disease. All participants have disclosures.Dr. Mammen has served as an expert witness for trials in 2010 and 2011; receives revenue for a patent on anti-HMGCR antibody detection technology; and received honoraria for Grand Round presentations at several universities.Prof. Hanna receives research funding from the Medical Research Council, MRC Center grant (G0601943), from the Muscular Dystrophy Campaign and the Consortium for Clinical Investigation of Neurological Channelopathies (CINCH) NIH grant U54 NS059065. M.G. Hanna provides the UK national patient referral center for skeletal muscle channelopathies funded by the UK Department of Health National Commissioning Group. Dr. Fugate serves on the editorial team for the Neurology® Resident and Fellow Section. Dr. Jeff Burns serves on the editorial board of the Journal of Alzheimer's Disease; has served on a scientific advisory board for the American Academy of Physician Education; has received publishing royalties for Early Diagnosis and Treatment of Mild Cognitive Impairment (Wiley Press, 2008) and Dementia: An Atlas of Investigation and Diagnosis (Clinical Publishing, 2007); serves on the speakers bureau for Novartis; has served as a consultant for Medacorp Consulting, Johnson County Clinical Trials, and PRA International; receives research support from Elan Corporation, Janssen, Wyeth, Pfizer Inc, Danone, and the Dana Foundation; and has served as an expert witness in legal proceedings regarding competency.Dr. Morris serves on scientific advisory boards for Eisai Inc., Esteve, Janssen Alzheimer Immunotherapy Program, GlaxoSmithKline, Novartis, Otsuka Pharmaceuticals Co., Ltd., and Pfizer Inc; serves on the editorial advisory board of Annals of Neurology; receives royalties from the publications of the books Mild Cognitive Impairment and Early Alzheimer's Disease, Dementia, Handbook of Dementing Illnesses, 2nd edition and for an editorial in Lancet Neurology; and receives research support from Janssen Alzheimer Immunotherapy Program and Pfizer Inc.

This episode discusses the pathophysiology, presentation, and treatment of NTSI.

An interview with Dr. Andrew Mammen about A novel autoantibody recognizing 200 and 100 kDa proteins is associated with an immune-mediated necrotizing myopathy, Arthritis Rheum. 2010 May 23.

An interview with Dr. Andrew Mammen about A novel autoantibody recognizing 200 and 100 kDa proteins is associated with an immune-mediated necrotizing myopathy, Arthritis Rheum. 2010 May 23.

An interview with Dr. Andrew Mammen about A novel autoantibody recognizing 200 and 100 kDa proteins is associated with an immune-mediated necrotizing myopathy, Arthritis Rheum. 2010 May 23.

We report the untypical clinical course of a previously healthy two-year-old girl, who died suddenly and unexpectedly after an episode of vomiting. At forensic autopsy no other pathological findings could be diagnosed than multiple reddish, sunken areas in brain stem, mesencephalon, and pons. Histologically they presented as areas of spongiosis of the neuropil with prominent endothelial hyperplasia and vascular proliferation whereas nerve cells were well preserved. On the basis of the characteristic neuropathological findings in combination with the age of the child, we had to take into consideration that the child might have died from subacute necrotizing encephalomyelopathy (Leigh's Disease) despite the untypical, fulminant clinical course.

The Society of Critical Care Medicine's president-elect Phil Barie, MD, MBA, FCCM, discusses a study published in Annals of Surgery, titled "Early Antibiotic Treatment for Severe Acute Necrotizing Pancreatitis." Dr. Barie is professor of surgery and public health at Weill Medical College of Cornell University in New York and was a co-author in this important study. (Ann Surg. 2007; 245: 674)

Bakterielle Toxine aktivieren spezifische Signalwege in humanen Zellen und modulieren so deren Funktion und Morpholgie. Ein besseres Verständnis der Effekte von Toxinen auf humane Zellen könnte zur Aufklärung der Pathogenese bakterieller Erkrankungen beitragen. In dieser Arbeit wurde der Effekt des Exotoxins CNF-1 aus Escherichia coli auf die Morphologie humaner Endothelzellen (HUVEC) und die beteiligten Signalwege untersucht. CNF-1 führt in HUVEC zeitabhängig sowohl zur Bildung von Aktinfasern als auch zur Ausbildung von "membrane ruffles" und Filopodien. Diese Aktinstrukturen werden durch Aktivierung der GTPasen Rho, Rac und CDC42 induziert. Rho führt in Endothelzellen über Rho-Kinase zu einer Myosinleichtketten (MLC)- Phosphorylierung und dadurch zur Hemmung von MLC-Phosphatase. Stimulation der Endothelzellen mit CNF-1 führt hingegen abhängig von Rho und Rho-Kinase ohne Hemmung der MLC-Phosphataseaktivität zu einem Anstieg der MLC-Phosphorylierung und einer Zellkontraktion. Es konnte gezeigt werden, dass zwar Rac und CDC42 in den ersten Stunden durch CNF aktiviert werden, diese aber nicht für die MLC-Phosphorylierung verantwortlich sind. 24h nach CNF-Stimulation zeigt sich immer noch eine Aktivierung von RhoA, nicht aber von CDC42 und Rac. Trotzdem kommt es zu einem Anstieg der MLC-Phosphatase und dadurch zu einem Abfall der MLC-Phosphorylierung und Zellausbreitung. Diese Ergebnisse zeigen, dass CNF zu einer Entkopplung des Rho, Rho-Kinase, Myosinleichtketten-Phosphatase-Signalweges führt. Diese Entkopplung könnte eine Rolle bei der pathologischen Wirkung des Toxins spielen.