Join us for a recap of this week’s robust Grand Rounds. We have a wide array of topics including biliary pathology, ED operations and how are decisions impact boarding, congenital long QT and Boerhaave syndrome, TTP, and pediatric stridor.
Read MoreWhat’d we cover in this week’s Grand Rounds? Dr. Mand expertly delivered her final Morbidity & Mortality conference of the year, covering a spectrum of pathology from pediatric cardiac arrest to BRASH syndrome. Dr. Ryan gave the second part of the highly informative medical malpractice series. Dr. Stark reviewed hand injuries for her R1 Clinical Knowledge, an EM bread & butter lecture series. To cap things off, Dr. Hunt reviewed an R3 case where she tamed the SRU.
Read MoreThis week we had the distinct privilege to learn about empathy from Dr. Ope Adeoye who explored what empathy looks like from the patient's perspective - and why it's difficult to be truly empathic as a young physician. We puzzled over a CPC case of severe chest pain in a young woman. Dr. Harty taught us about the not-so-elusive TACO and TRALI among other transfusion reactions. Finally, Dr. Wurster-Ovalle gave us some pointers on management of unvaccinated children with fever in the ED.
Read MoreBoerhaave's syndrome: Full thickness esophageal perforation
Thought to be due to suddenly increased intra-esophageal pressure
60% of perforations thought to be iatrogenic, most commonly related to upper endoscopy
Chest X ray most of the time will have some abnormality, although it may just appear as a pneumonia. Pneumopericardium and obvious signs of mediastinitis may be rare on initial chest X ray, especially early in the disease process or with smaller esophageal tears and less mediastinal inoculation
CT scan is diagnostic modality of choice. If unavailable, upper GI series with Gastrograffin (less sensitive than barium though also less inflammatory reaction) is a better option that barium (greater sensitivity, more associated inflammation/potential for mediastinitis).
Treatment is broad spectrum antibiotics as a broad spectrum of oral and pharyngeal bacteria can be involved
Mortality is high and increases drastically with delays in diagnosis
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 MoreSRU (pronounced "shrew") = Shock Resuscitation Unit
Training in, and managing, the SRU is one of the crown jewels of our residency. It is where the sickest of the sick patients are found in our ED. It is a crucible, a test of knowledge and strength, and a true manifestation of the tripartite mission of our department: Leadership, Excellence, and Opportunity.
Training in, and managing, the SRU is one of the crown jewels of our residency. It is where the sickest of the sick patients are found in our ED. It is a crucible, a test of knowledge and strength, and a true manifestation of the tripartite mission of our department: Leadership, Excellence, and Opportunity.
