Grand Rounds Recap 02.08.2017

Grand Rounds Recap 02.08.2017

This 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.

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Grand Rounds Recap 1/13

Grand Rounds Recap 1/13

R1 CLINICAL KNOWLEDGE ON ESOPHAGEAL EMERGENCIES WITH DR. CONTINENZA

Boerhaave'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

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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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