Episode 99 Highlights from EMU 2017

This is EM Cases Episode 99 Highlights from EMU 2017. North York General Hospital's 30th Annual Emergency Medicine Update (EMU) Conference 2017 featured some of the best talks I've ever heard from the likes of Sara Gray, Amal Mattu, David Carr and many more. I had a hard time choosing which talks to feature on this EM Cases podcast. I settled on a potpourri of clinical topics and practice tips: Leeor Sommer on Lyme disease, Chris Hicks on signover, Matt Poyner on patient complaints and Walter Himmel on acute vestibular syndrome... Podcast production, sound design & editing by Anton Helman Written Summary and blog post by Alexander Hart & Shaun Mehta, edited by Anton Helman August, 2017 Cite this podcast as: Helman, A, Sommer, L, Hicks, C, Poyner, M, Himmel, W. Highlights from EMU 2017. Emergency Medicine Cases. https://emergencymedicinecases.com/episode-99-highlights-emu-2017/. Accessed [date]. Lyme Disease from EMU 2017 with Leeor Sommer Lyme is spreading around North America and Europe and should now be considered endemic in many areas. The incidence is rising and might be much higher than is reported. Early diagnosis is key to preventing disseminated Lyme disease and treatment of acute Lyme disease is very effective. Distribution of Lyme Disease U.S. The Lyme Bug Black legged Ixodes tick (care of Wikipidedia) Borelia burgdoferi is spread via the black legged Ixodes tick. Ixodes in its nymph form can also spread disease and at 1mm in size, can go undetected much more easily. The Lyme Disease Presentation Lyme disease has several presentations which can grossly be divided between acute Lyme disease and disseminated Lyme disease. Acute Lyme Disease Presentation About 3/4 of patients with acute lyme disease present with rash, fever, flu-like illness in the spring or summer months. Think of acute Lyme disease when a patient presents with a flu-like illness in these seasons. The Rash of acute Lyme disease is most often the classic Erythema Migrans bull's eye type, but can also be an erythematous patch with a central scab or simply one or more erythematous patches with blurred margins. Erythema Migrans "Bull's eye" rash of acute lyme disease Erythmatous patch with central scab consistent with acute lyme disease Disseminated Lyme Disease Presentation A much more serious and refractory illness Think of disseminated Lyme in the setting of: * Bilateral 7th nerve palsy (this is almost pathognomonic) * Aseptic meningitis in summer * Heart block, including really long (>300ms) 1st degree HB (Lyme carditis) * Acute mono-arthritis with large effusions of large joints.  Clinical Pearl: If a patient suspected of Lyme disease has a 1st degree heart block on ECG, consider admission as many of these patient will go on to develop 3rd degree heart block. Lyme Disease Diagnosis Remember that testing for Borelia early in the acute disease state will be negative. Borelia is a slow growing bacterium and does not trigger the IgM/IgG response the assay requires until much later. To prevent disseminated Lyme,