Grand Rounds Recap 3.29.2017

Grand Rounds Recap 3.29.2017

Dr. Grosso kicked off Grand Rounds this week with March M&M by diving deep into some core content, including BB and CCA overdoses, influenza, massive transfusion, post-intubation hypotension, and neurological catastrophes causing cardiac arrest. Dr. O'Brien broke down coagulopathy of liver disease and DIC for us while Dr. Golden taught us about febrile seizures. Drs. McKee and Colmer talked through the evidence behind their CPQE pathway on vent management in obstructive lung disease. Drs. Liebman and Powell went head to head in a CPC case about sternal osteomyelitis to round out another excellent week of learning. 

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Annals of B-Pod: #lessonslearned

Annals of B-Pod: #lessonslearned

Beware! Aortic Dissection

#lessonslearned is a case series submitted by former senior residents describing B-pod cases that taught them the art of medicine

Case 1

A male in his 30s with a past medical history significant for hypertension presented via EMS with pain all over, anxiety and shortness of breath. The EMTs reported that he had smoked marijuana about 30 minutes before his presentation from his normal supply. At the scene he was noted to be very agitated, diaphoretic and vocal about his pain. He was yelling that he was hurting all over, he was having trouble breathing, and that he wanted to be sedated. He states that he has never had problems like this.

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Pediatric Abdominal Ultrasound

Pediatric Abdominal Ultrasound

After a long shift in the adult ED, jam packed with patients presenting with abdominal pain, your looking forward to a brand new day in the Peds ED.  Your first patient, however, gives you PTSD-like flashbacks to the previous days shift.  

Alice is a 8 year old girl who developed abdominal pain last night.  Her parents thought that she would be okay waiting until morning, that the pain would pass in the night.  On waking this morning, however, the pain was still there.

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The Approach to Abdominal X-rays

The Approach to Abdominal X-rays

Utility of the imaging modality aside, abdominal radiographs can be a bit of a challenge to interpret.  With a number of possible techniques (cross table laterals, left lateral decubitus, AP, upright, or supine) and a lot of structures to evaluate (is that small bowel or large bowel?, is that a kidney stone or an infamous phlebolith?), it's pretty easy to stare at a film and zone out as you eye moves from one shade of gray to another.

In the embedded video below, PGY-1 resident, Dr. Julie Teuber goes through a standardized approach to reading the abdominal x-ray that hopefully help keep your eyes from going cross-eyed next time you need to interpret an acute abdominal series.

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