Topics in this EM Quick Hits podcast

Megan Landes on the importance of diagnosing HIV in the ED (1:10 )

Jesse McLaren on the failed paradigm of STEMI criteria and ECG tips to identify acute coronary occlusion (22:33 )

Anand Swaminathan on evidence for non-invasive airway management in the poisoned patient (29:25 )

Brit Long and Hans Rosenberg on the identification, workup and management of spontaneous bacterial peritonitis (37:32 )

Matt Poyner on the most lucrative side-gig, DIY investing (46:34 )





Podcast production, editing and sound design by Anton Helman

Written summary & blog post by Shaila Gunn & Megan Landes, edited by Anton Helman

Cite this podcast as: Helman, A. Landes, M. McLaren, J. Swaminathan, A. Long, Rosenberg, H. B. Pointer, M.  EM Quick Hits 57 - HIV diagnosis, Failed Paradigm of STEMI Criteria, Poisoned Patient Airway Management, Spontaneous Bacterial Peritonitis, DIY Investments. Emergency Medicine Cases. June, 2024. https://emergencymedicinecases.com/em-quick-hits-june-2024/. Accessed July 3, 2024.

HIV diagnosis and why it's important in EM



HIV is a commonly missed diagnosis. 1 in 7 HIV+ Canadians are unaware of their diagnosis.

For many people at high risk for HIV, the ED is the only accessible place to get tested. An early diagnosis saves lives by initiating early treatment, thus preventing transmission of the infection by 96% (undetectable = untransmissible).

In whom should we consider testing for HIV in the ED?

1a) Major risk factor for HIV - persons who inject drugs (PWID), indigenous people, and people from endemic areas, suspect TB plus

1b) Clinical condition associated with HIV







* Acute retroviral syndrome: an influenza like illness that happens within the first month of seroconversion. Influenza like illness + risk factor = think HIV.

* Opportunistic infections: may include angular cheilitis, aphthous ulcers, oral candida, and hairy leukoplakia (from left to right in image below). The clues are in the mouth, so examine it! Be suspicious of unexpected weight loss and chronic diarrhea.







Opportunistic infections of the mouth in people with HIV, from left to right, angular cheilitis, aphthous ulcers, oral candida, and hairy leukoplakia







* AIDS defining illnesses: severe wasting, esophageal candida, and PCP/PJP pneumonia (may be identified by characteristic 'bag wing' bilateral pneumonia) are the most common. Also consider unusual CNS presentations including altered mental status, meningitis, and encephalitis.







2.Anyone who requests a test

3. Unexplained pancytopenia



* Other risk factors for HIV: People presenting with any STI,  people with multiple sexual partners and people with recurrent presentations for post-exposure prophylaxis (PEP).



=> Integrating IVDU and sexual history into your history for all adult patients presenting with a fever will improve your diagnostic pick up rate of HIV

Testing should be done through whatever means you have access to at your institution. This may include point of care testing, self-testing with oral swabs, or lab-based antigen-antibody tests. Note, if the test if negative and you have high suspicion, repeat testing in 1-3 months as false negatives are common early in the natural history of HIV.

Other illnesses to be aware of in HIV+ patients



* Immune reconstitution inflammatory syndrome: This is a paradoxical worsening of any pre-existing infectious pr...