This week’s grand rounds started with Dr. Colmer reviewing some fascinating cases in this months Morbidity and Mortality. We then split up into groups and did the quarterly sim focusing on informed consent led by Drs. LaFollette and Lang. This was followed by some challenging oral boards cases chosen by Drs. McDonough and Hill. Look forward to next week!Read More
This week we recap the latest IOM recommendations on cardiac arrest management, evidence-based update on anaphylaxis management, management of the morbidly obese code and discuss the ins and outs of immunosuppressive agents.Read More
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.Read More
It's weird how you get runs of patients in the ED. Some days it seems like it's nothing but wall-to-wall low risk chest pain, altered mental status, or back pain. Today (and a lot of other days), it's abdominal pain. Scanning the board you see seemingly nothing but Level 3 acuity patients with the chief complain of "Abdominal pain." Out of the scores of patient's, you seen so far, the last 2 worry you the most:
Andrea is a very pleasant 20 year old student from a local college. She came in after having symptoms of right lower quadrant pain over the course of the past 8-12 hours. She didn't recall any migratory symptoms but does endorse a lack of appetite, nauseousness, 2 episodes of vomiting (started after the pain), and steadily worsening pain.Read More
CPC with Dr. Boyer vs. Dr. Steuerwald
16yoF with 4 days of bilateral lower quadrant abdominal pain and diarrhea that was tachy, dry, and with a diffusely tender abdomen and some right-sided discomfort on pelvic exam with a mild leukocytosis.
Dr. Steuerwald's approach to listening to patient presentations: Pick out the main symptoms, get a time course, and listen for any other true "weirdness" then build your own timeline of events.
- Don't forget about the "sexy numbers" in everyone, these include the vitals and also key aspects of a disease process (i.e. the EF in a patient with CHF)
- DDx included appendicitis, PID, TOA, Fitz-Hugh Curtis, Ovarian Torsion, Yersinia enterocolitis
- Dr. Steuerwald correctly identified the need to get a RLQ US to assess for appendicitis!