Case Conference Summary, October 11, 2017

Some rapid fire review of cases presented by our residents this week:

Leslie Adrian presented a pediatric case with a young male complaining of abdominal pain after sustaining a handle bar injury to the abdomen after falling off his bike.  Initial vital signs showed tachycardia and age adjusted hypotension.  He had RUQ abdominal pain on examination and a FAST was positive.  He was stable enough for CT scan which showed a large liver laceration and ultimately taken to the OR for definitive management.  She did an excellent job of reviewing the literature on management of blunt pediatric abdominal trauma.  In particular, management has changed dramatically recently, with hemodynamic and clinical status guiding management of solid organ injury versus grade of injury.  In particular, for blunt liver trauma the following algorithm applies:

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Medical Student Corner – “If your patient is sweating, so should you…”

Authors: Patrick Mescher, OSU MS4 // Michael Barrie, MD OSUEM

Standing in the physician’s office of a local Emergency Department I heard the familiar clunk of a chart being dropped into the metal bin. I walked over and picked up the chart and read “Chief Complaint: Chest Pain,” thinking to myself how this was the fifth “chest pain” I’ve seen this shift. After diagnosing GERD, costrocondritis, and pneumonia with previous patients, I felt comfortable evaluating this chief complaint so I went calmly to the patient’s room. But as I walked to the bedside I found a visibly uncomfortable patient, profusely perspiring. He told me he was having crushing chest pain. I was immediately concerned this may be the real deal STEMI.

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