Tasty Morsels of EM 085 – #FRCEM HIV Emergencies (expanded)

27 Jul

I’m entering a few months prep for the UK and Ireland exit exam in Emergency Medicine: the FRCEM. I’ll be adding lots of little notes on pearls I’ve learned along the way. A lot of my revision is based around the Handbook of EM as a curriculum guide and review of contemporary, mainly UK guidelines. I also focus on the areas that I’m a bit sketchy on. With that in mind I hope they’re useful.

You can find more things on the FRCEM on this site here.

Interestingly I’d written about this 4 years ago reviewing a series of AFJEM articles. It’s all still very relevant and worth a look but this is a little update for the exam specifically. This is of course not comprehensive.

From the OHEM and the 2011 BAHIV guidelines

What are the features of Pneumocystis Jirovecii?

  • Fungal
  • Only found in the immunocompromised
  • usually in CD4<200
  • Insidious onset over weeks with SOB on exertion
  • LDH usually >500
  • If you’re lucky CXR looks like this:

Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org. From the case rID: 9171

  • Or you might find a pneumo but it can be fairly normal (quoted in up to 40%)
  • Exertional desaturation is useful (what do you mean you don’t walk your patients in the ED?!?)

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How do you treat it?

  • Treatment
    • the key threshold is PaO2 <70mmhg (or 9.2kPa)
    • If below threshold then IV co trimoxazole and steroids (40mg BD prednisolone)
    • If above the threshold then oral co trimoxazole

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What are the features and treatment of Cryptococcal meningitis?

  • Headache, fever, usually without neck stiffness
  • Remember headache with HIV is a reason to do a CT before LP
  • Fungal
  • ICP is often high so expect vomiting
  • Treatment
    • amphotericin B
    • LP can be therapeutic. If pressure >25cmH20 then keep draining till below 20cmH2O

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What are the features of Toxoplasmosis?

  • A protozoa
  • cat poo the famous way to get it
  • Eye disease

via International Centre for Eye Health www.iceh.org.uk, London School of Hygiene & Tropical Medicine. on Flickr

  • Brain disease
  • Might look like this:

Case courtesy of Dr Augusto César Vieira Teixeira, Radiopaedia.org. From the case rID: 23270

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What is CMV Retinitis?

  • usual eye symptoms
    • blurry
    • flashers
    • floaters
  • can cause detachment
  • might look like this

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