Snake Venom Poisoning - A Medical Emergency

Snake Venom Poisoning - A Medical Emergency

Presentation text by Robert Norris, MD, FACEP
Associate Professor, Surgery
Chief, Division of Emergency Medicine
Stanford University

Topics covered.

Objectives
Introduction
Identification of u.s. Snakes
Anatomy
Venom
Signs and symptoms of snake venom poisoning
Factors effecting severity of envenomation
Grading severity of envenomation severity grading
Laboratory analysis management of snake venom poisoning
Method of antivenom administration
Suggested starting doses
Management of the patient with an allergy to antivenom and a severe envenomation
Ddisposition
Mmorbidity and mortality
A note on exotic venomous snakebite in the u.s.
Suggested reading - published journal articles

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26 Rheumatology presentations

USA College of Rheumatology contains 26 presentations

1. Slide
   Fibromyalgia- Diagnostic Criteria American College of Rheumatology (1990) Hx of widespread pain; present for at least 3 months; Pain in 11 of 18 tender point sites
   www2.medicine.wisc.edu/.../genintmed/12-12-07-Smith PCC 12 Dec 2007.ppt
2. Mixed Connective Tissue Disease: Still Crazy After All These ...
   Venables PJW. “Mixed Connective Tissue Disease.” Lupus, 2006. 15: 132-137. American College of Rheumatology, classification criteria for SLE.
   www.med.unc.edu/medicine/web/3.12.08 MCTD Kahl.ppt
3. Pulmonary Board Review
   The American College of Rheumatology proposed clinical criteria for patients enrolled in studies of Wegener's and distinguish other forms of vasculitis (pre-ANCA)
   www.med.unc.edu/medicine/web/6.16.08. Escher HW. Pulm Board Rev.ppt
4. Rheumatoid Arthritis
   1987 American College of Rheumatology Revised criteria for the diagnosis of Rheumatoid Arthritis: At least four of the following
   www.lhup.edu/asmith7/Rheum/rheumatoid arthritis.ppt
5. American College of Rheumatology –not intended to be used in routine clinical practice and established before ANCA. Presence of 2 or more yield 88% sensitivity and 92 ...
   www.med.unc.edu/medicine/web/10.5.07 Wegeners Ezzeddine.ppt
6. Unknown #104
   American College of Rheumatology classification criteria . Unexplained weight loss > 4 kg; Livedo reticularis; Testicular pain; Myalgias; Mononeuropathy or polyneuropathy
   medicine.georgetown.edu/residency/unknowns/unknown104.ppt
7. Medical Terminology 101: Enhancing the Content Review Process
   ASH: American Society of Hematology; ASH: American Society of Hypertension; ACR: American College of Rheumatology; ACR: American College of Radiology
   www.iche.edu/.../Alliance 2009. Med Term 101. Final. Release.ppt
8. NIMH Working group on Definitional Criteria for HIV-associated ...
   NIMH Working group on Definitional Criteria for HIV-associated Dementia, (AIDS ... Example from Rheumatology
   synapse.neurology.unc.edu/.../introduction mcarthur.
9. Drug
   American College of Rheumatology proposed the following five criteria. The presence of three or more had a sensitivity of 71% and a specificity of 84% for the diagnosis
   www.med.unc.edu/medicine/web/Drug Eruptions, 2-8-06.ppt
10. Solid Food Dysphagia
    Rheumatology (Oxford) 1999; 38:917. Ramirez-Mata M, Reyes PA, Alarcon-Segovia D et al. Esophageal Motility in systemic lupus erythematosus.
    www.mcw.edu/.../GrandRoundsPresentations/Mediastinal_Lymphoma_Massey.
11. Infective Endocarditis
    More common in subacute IE . American College of Rheumatology. webrheum.bham.ac.uk/.../ default/pages/3b5.htm . www.meddean.luc.edu/.../ Hand10/Hand10dx.html
    www.dartmouth.edu/.../Fellowship/powerpoints/Infective Endocarditis[1].ppt
12. Slide
    There have been several attempts, most notably by the American College of Rheumatology (ACR) in 1990 and the Chapel Hill Consensus Conference of 1994, to create clear ...
    medicine.georgetown.edu/residency/scholarly/researchday2008/Bender 5-5-08.ppt
13. Orthopedics
    This excellent site details the ACR (American College of. Rheumatology) clinical classification criteria. Please take a . look – you won’t believe how detailed it is!
    home.sandiego.edu/~pquinn/ortho chronic.ppt
14. Case Intro
    American College of Rheumatology diagnostic criteria; Palpable purpura; Age <20;>
    www.stritch.luc.edu/.../morning_report_repository/Henoch-Schonlein Purpura.ppt
15. Lupus Anticoagulant
    Only about 50% of individuals with a lupus anticoagulant meet the American College of Rheumatology criteria for the classification of lupus (SLE)
    pathology.columbia.edu/.../current/cp/special_hematology/lupus_anticoagulant.
16. Rheumatoid Arthritis & Anti-CCP Antibody
    RA Classification criteria – 1987 American College of Rheumatology . Morning stiffness in and around the joints lasting at least 1 hour
    www.med.unc.edu/medicine/web/8.28.07 RA and CCP Griffiths.ppt
17. Gender Differences in Immune Response
    As revised in 1997 by the American College of Rheumatology) A person is said to have SLE if four of these criteria are present at any time:
    www.pitt.edu/~super7/19011-20001/19791.ppt
18. Slide
    Diagnostic Criteria . American College of Rheumatology Diagnostic Criteria (1990) 1; Pain in all 4 quadrants of body and axial skeleton.
    depts.washington.edu/rheum/respapers/fouch.
19. Welcome to Dermatology
    The American College of Rheumatology: 5 criteria for the classification of hypersensitivity vasculitis in a patient with vasculitis; Age >16 years
    www.meddean.luc.edu/depts/cme/MRCME-Dermatology.ppt
20. Henoch-Schönlein Purpura
    American College of Rheumatology classification criteria; Palpable purpura; Age of onset <= 20 years; Acute abdominal pain; Biopsy showing granulocytes in walls ...
    www.med.unc.edu/medicine/web/1.30.09 Craig. HSP.ppt
21. Takayasu’s Arteritis
    1990 Criteria of American College of Rheumatology for the Classification of Takayasu’s Arteritis . Definition . Criteria . Development of symptoms or findings related to Takayasu ...
    www.meddean.luc.edu/depts/cme/MRCME-Takayasu's.
22. Fibromyalgia Syndrome (FMS)
    The American College of Rheumatology’s Criteria 1: Widespread musculoskeletal pain for at least 3 months; Axial skeletal pain; Pain in at least 11 out of 18 trigger points
    hercules.gcsu.edu/~mmartino/Fibromyalgia.ppt
23. Soft Tissue Rheumatism
    Soft Tissue Rheumatism . Gary Kunkel, M.D. Division of Rheumatology. November, 2005. Objectives . Recognize key features of the most common types of bursitis and ...
    umed.med.utah.edu/ms2008/Vault/MuscSkel/20051121-2-SoftTissueRheumatism.
24. The Role of 5-ASA Agents in the Treatment of Mild and Moderate
    Perez JL, et al. Presented at: American College of Rheumatology Annual Meeting; October 21, 2004. Keane J, et al. N Engl J Med. 2001;345:1098-1104.
    www.meddean.luc.edu/depts/cme/PresentationBarrett-IBD.ppt -
25. Living With Co-Morbidity: A Study of Women with Systemic Lupus
    American College Rheumatology Criteria for SLE Diagnosis (M =5.59 criteria, range of 1 to 10 to make diagnosis) 47% Malar rash; 35% Discoid rash
    www.utmb.edu/cirwh/ppt files/100302weaver.ppt
26. Pharmacologic Treatments
    Arnold LM et al. Arthritis Rheum. 2004;50:2974-2984; Wernicke JF et al. Presented at: 68th Annual Scientific Meeting of the American College of Rheumatology; October 16-21 ...
    www.mc.uky.edu/womenshealth/content/pharm-treatments.pps

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Osteoporosis Clinical cases and literature review

Osteoporosis Clinical cases and literature review
Presentation by Catherine Bakewell, MD

Overview
Risk Factors
Screening
Treatment of Osteopenia
EBM
Problems? Flaws?
Study limitations
What doses do you recommend?
Vitamin D
Calcium
Counselling
Bisphosphonates for Osteopenia
Physiologic effects
Guidelines
Conclusions
What about other therapies?
Calcitonin
Estrogen
Selective Estrogen Receptor Modulators
Intermittent PTH
Glucocorticoid induced bone loss
Mechanisms for glucocorticoid induced osteoporosis
General guidelines
Screening
Supplementation
HRT
Bisphosphonates
What would Schousboe say?
Calcitonin
Thiazides
References

Osteoporosis Clinical cases and literature review.ppt

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