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:
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.
Thanks Dr. Daniel Francescon for putting this together from our recent Rapid Fire Case Conference!
AMP Case conference review 9/20/17
Welcome back to another installment of Academic Medicine Pearls from THE Ohio State University. This week’s presenters shared with us their stories of bleeding and rapidly declining respiratory statuses. Continue reading
Author: Hiro Miyagi OSU MS4 // Editor: Michael Barrie OSU EM Attending
Medical Student Corner – When do kidney stone patients need immediate intervention?
A 51yo female presents with an acute episode of severe right sided back pain with nausea and vomiting. Patient has a past medical history of HTN and chronic back pain. The pain is intermittent, described as sharp and stabbing 10/10 pain. She has not been able to tolerate any liquids since the onset of pain. The patient denies fevers or chills, with no recent infections or illnesses. No dysuria, but with mild urinary frequency. She has a past surgical history of appendectomy 30 years ago.
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?
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).
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: