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:

Continue reading

Advertisements

Case Conference Summary, August 16, 2017

Thanks to Dr. Daniel Francescon for putting together the following summary of Rapid Fire Case Conference, August 16th:

Dr. Schirm presents a case of a 47F with the common complaint of elbow pain. It has been worsening for the past three weeks and is exacerbated by movement, especially when lifting objects at her job. She denies any fevers or trauma to the area. Physical exam is significant for point tenderness over the lateral epicondyle with full range of motion. She is neurovascularly intact distally. Dr. Schrim forgoes an X-ray and diagnoses the patient with lateral epicondylitis (tennis elbow).

Continue reading

Case Conference Summary, August 9, 2017

Case Conference Summary, August 9, 2017

This week in Rapid Fire Case Conference we had a number of great clinical cases and educational pearls.

Dr. Patrick Sylvester presented a case of an elderly gentleman who presented with complaints of fatigue. On arrival he was noted to be hypotensive and diaphoretic. Physical examination revealed JVD and muffled heart sounds. He astutely used bedside ultrasound and saw this:

Continue reading

Cardiogenic Shock and Peri-Intubation Arrest – It Happens

By Zach Adams MD, OSUEM PGY2 // Edited by Michael Barrie MD, OSU EM Assistant Professor

A 65 year-old patient presents with a history of ischemic cardiomyopathy and multiple medical co-morbidities. Initial triage vital signs show a BP of 83/40 with a pulse of 120 and oxygen saturation of 92%.  He appears in extremis.

On initial evaluation, the patient is mentating well but complaining of shortness of breath. Heart sounds are distant and lungs are otherwise clear.  You note mottled peripheral extremities, which appear cyanotic and are cold to touch.  He tells you that he was recently hospitalized, but does not know what and whether or not he is still being treated.

While obtaining initial lab studies and getting the patient hooked up to the monitor, you perform a RUSH exam and note extremely poor systolic function of the left ventricle and the IVC is distended without respiratory variation.  You suspect this is cardiogenic shock.  What is cardiogenic shock?  What are your next steps in management?

Continue reading