Grand Rounds Recap 10.19.22

Grand Rounds Recap 10.19.22

This week’s grand rounds features a discussion on the treatment and complications of inflammatory bowel disease with Dr. Hajdu, a CPC showdown and discussion of appendicitis with Drs. Gobble and Urbanowicz, an overview of hand injuries in the community with Dr. Betz, and an intense Taming the SRU case of a traumatic aortic injury with Dr. Kein.

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Grand Rounds Recap 02.03.2021

Grand Rounds Recap 02.03.2021

This week Dr. Freiermuth showed us how to create a research project. Drs. Tillotson and Makinen discussed the evidence on open fracture management. The R2 CPC between Drs. Ramsay and Nagle taught us an important lesson on HIV and ITP. Finally, Drs. Iparraguirre, Li, Makinen, and Mand created a simulation to teach management of a pediatric nicotinic poisoning.

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Grand Rounds Recap 01.06.2021

Grand Rounds Recap 01.06.2021

The first grand rounds of 2021 offered many learning points to help us ring in the New Year! Dr. Neel from the Department of Neurology gave us some great tips on the neurologic exam and some quick hits on neuromuscular diseases. The residents then worked together to come up with some challenging diagnoses. The day was rounded off with oral boards preparation with cases of: pediatric appendicitis, stroke in a non-stroke center, and a PE with an underlying malignancy.

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Grand Rounds Recap 04.15.20

Grand Rounds Recap 04.15.20

We had another exemplary installment of Grand Rounds this week that started with Attending Case Followup with Drs. Lang, Baez, and Paulsen. Then we had some top-notch review of core curriculum with Dr. Winslow and the Alvarado Score for appendicitis, Drs. Meigh and Klaszky on food impactions and esophageal foreign bodies, and Drs. Comiskey and Nagle on D-dimer. Finally, Dr. Nagle gave us an overview of the foundations of evidence-based medicine with his R4 capstone.

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To Appendectomy or Not to Appendectomy: The Alvarado Score

To Appendectomy or Not to Appendectomy: The Alvarado Score

Appendicitis is the most common surgical emergency that emergency physicians encounter each year. The prevalence of appendicitis in the US is estimated at 7%, with an incidence of 9.38 per 10,000 people annually [1,2]. Appendicitis shares many signs, symptoms, and laboratory features with other acute medical and surgical conditions, including diverticulitis, nephrolithiasis, and ovarian pathologies like tubo-ovarian abscess and ovarian torsion. Diagnostic tools such as the Alvarado score are designed to help emergency clinicians sharpen their diagnostic acumen by stratifying the likelihood of appendicitis based on scoring systems

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Grand Rounds Recap 2.20.19

Grand Rounds Recap 2.20.19

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!

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Grand Rounds Recap - 11/18

Grand Rounds Recap - 11/18

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.

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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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CT Abdomen and Pelvis - Hollow Viscus

CT Abdomen and Pelvis - Hollow Viscus

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.

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Grand Rounds Recap 1/7/14

Grand Rounds Recap 1/7/14

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!
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