Blood Transfusion Thresholds
■ Sepsis: 7 g/dL
■ Upper or lower GI bleeds: 7 g/dL
■ Acute neurologic injury or TBI : 7 g/dL
■ Stable CV disease: 8 g/dL
■ ACS: 10 g/dL
Calculating Total Body Surface Area (TBSA) is crucial in determining initial fluid resuscitation and potential disposition. The Rule of 9s is inaccurate and consistently overestimates TBSA by about 20% which can lead to over-resuscitation.
For TBSA <15%: The Rule of Palms is highly accurate and easy to teach. Use the size of the patient's hand (including the fingers) to estimate burn size.
Lemierre’s syndrome - septic thrombophlebitis of the internal jugular vein
Lemierre’s syndrome is an uncommon complication of pharyngitis usually caused by Fusobacterium necrophorum, an anaerobe, that leads to suppurative thrombophlebitis of the internal jugular vein and subsequent disseminated infection, often with septic pulmonary emboli.
It usually presents as a prolonged pharyngitis in a patient who is febrile, appears ill, has asymmetric anterior neck swelling, often pleuritic chest pain, shortness of breath, and often tachypnea with abnormal oxygen saturation. It is diagnosed with CT neck (and usually chest) with contrast. It’s treated with broad spectrum antibiotics that cover anaerobes, such as piperacillin-tazobactam or ampicillin-sulbactam, often in an ICU setting.
Modified Brooke/Parkland Formula
The formula is recommended as a starting point for fluid resuscitation for burns >15% BSA in children and >20% BSA in adults.
Titrate rate of fluid for a urine output of 30-50cc/hr in adults and 0.5-1cc/kg/hr in children. Increase or decrease resuscitation fluid rate by 30% if hourly target not reached.
The mount Fuji sign of tension pneumocephalus
Tension pneumocephalus is a neurosurgical emergency that occurs when subdural air causes a mass-effect over the underlying brain parenchyma, often from a ball-valve mechanism causing one-way entry of air into the subdural space .