Educational game time!

[DarEMT]

Just to clarify, you agree or disagree?

Staphylococcus aureus, Haemophilus influenzae, and Pseudomonas aeruginosa are in fact the three most common bacteria that cause lung infections in CF patients. While I agree there are many others and some can be more common, the three mentioned are the most common when considering the CF population as a whole.

Take care,

chbare.

Yes, chbare, sorry, I do agree....the only thing I disagreed with was the age thing...0-18 not seeing psuemonas (sp)....my girls have grown that for years.....LoL...thanks for asking for clarification.

And yes, I also agree that Staphylococcus aureus, Haemophilus influenzae, and Pseudomonas aeruginosa are the most common "bugs" that cause problems in CF's, while the healthy population can get those bugs and they only cause mild infections that we usually don't even know about or go to the doctor with because our bodies fight them off....

Thank you and thanks for your knowledge....and interest.

~Deb

Benign Early Repolarization

What I know:

BER is one of the classic STEMI mimickers. The repolarization phase of the action potential, for some reason I don't know exactly, occurs slightly earlier resulting in an elevation of the ST segment of the ECG. I know that BER occurs more often in the young, especially thin African American males. Also, the usual presentation is precordial ST elevations in the absence of supporting cardiac signs or symptoms.

Research results:

There is no Wikipedia page on BER. LOL.

BER is a benign condition that exists in approximately 1% of the population. Interestingly, however, the percentage is much higher among patients presenting to the emergency department with chest pain. I've come across several estimates ranging from 25 to 50 percent. Of those patients, 80% will have precordial ST elevations of less than 2mm. Only 2% will have elevations above 5mm. Almost all of BER ST elevation occurs in the precordial leads V2-V5. Limb lead elevations are rare and usually much smaller (80% of the time less than 0.5 mm).

The etiology of BER has not been formally studied and to the best of my knowledge is not known.

BER is a STEMI mimicker and in the emergency medicine setting should be used as a diagnosis of exclusion. That means that patients should not be assumed to have BER until more dangerous conditions have been ruled out (AMI and pericarditis especially). In fact, though the condition has largely been considered benign (hence it's name!), recent studies (here and here) are suggesting that patients with BER actually have poor outcomes down the line.

Specific criteria for diagnosis of BER (from here):

1. ST segment elevation.

2. Upward concavity of the initial portion of the ST segment. (**like a smile not a frown**)

3. Notching or slurring of the terminal QRS complex.

4. Symmetric, concordant T waves of large amplitude.

5. Widespread or diffuse distribution of ST segment elevation on the ECG.

6. Relative temporal stability. (**ECG does not evolve, clinical condition remains stable**)

Also, here is an excellent 14 minute video on the subject that I found.

Sorry I couldn't find more information!

Next question: DKA is a fairly common condition that we run across. It produces a special kind of metabolic acidosis called an anion gap acidosis. Can someone tell us about DKA and how exactly it produces an anion gap acidosis (and what that is exactly!).

[chbare]

No problem, I thought that is what you were meaning to say.

Take care,

chbare.