Airway Corner with Dr. Kaide

Dr. Kaide’s Airway “tip of the month”

There was this hypothetical patient…who was being intubated.  As soon as the patient was paralyzed dark blood came pouring out into the mouth from an upper GI bleed. The resident immediately suctioned a continuous flow of blood from the airway. She could not see any airway structures because of the bleeding.  Now what?

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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).

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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:

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Acute Chest Syndrome

Authors: Kenneth Akapo, OSU MS4 // Dr. Michael Barrie, OSU EM Attending

A 24 year old female with history of sickle cell disease presents with a 6 hours history of widespread pain. The pain is in her lower back but also present within the lower and upper extremities. She also endorses mild shortness of breath although she attributes this to her pain episode. She mentions being seen a week ago due to a similar episode during which she also had new onset headaches associated with blurry vision. During that episode, CT scan was unremarkable. During the current encounter, there was low concern for ischemic stroke. The headaches have persisted until now, however, she no longer endorses changes in vision. She also denies any other focal neurologic symptoms.

Upon initial examination, the patient appeared to be in mild distress. She was mentating well and exhibited no focal neurologic symptoms.  She was diffusely tender to palpation although she seemed to exhibit more pain when palpating the lower extremities and back. Breath sounds were clear to auscultation bilaterally, and cardiovascular exam was normal.

Before presenting the case to the senior resident, you consider your differential diagnosis – sickle cell pain crisis, acute chest syndrome (ACS), ischemic stroke, acute coronary syndrome (the other ACS), and heart failure among others.

But what findings would help support or refute a diagnosis of acute chest syndrome? And what is the plan to manage the initial diagnosis and treatment of possible acute chest syndrome?

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