Dr. Stolz started Grand Rounds off with a great talk on lung ultrasound. Our consultant of the month, Dr. Hebbeler-Clark, gave a talk on patient safety and swarms. Dr. Lipshaw, a Peds-EM fellow, discussed the differential, evaluation, and management of congenital heart disease babies in the Emergency Department. Finally, Dr. Teuber ended with an interesting discussion on priapism.Read More
This week's grand rounds started off with our EMS team represented by Dr. McMullan updating us on new EMS stroke protocols, an upcoming trial for pre-hospital ketamine use, as well as a refresher on notification calls. This was followed by Dr. Shaw, who made his grand rounds lecture debut discussing the diagnostic and clinical utility of lactate. Drs. Harty and Toth then went mano-a-mano in another installment of the CPC lecture series, during which they discuss the presentation, workup and management of carotid cavernous fistula. Dr. Gorder then presented her clinical soap box, using the example of NG tube placement for SBO as a platform for addressing the impact of dogma within medicine. Our peds EM colleagues then steered the ship for the final 2 hours, discussing 2 oral boards cases (fussiness in a newborn and HSP) as well as putting on a pediatric trauma simulation.Read More
You are sitting on the helipad during your UH shift talking with the flight nurse when the tones drop for a pediatric scene call. You gather yourself after you have that crap your pants moment that everyone has with pediatric scene calls and whip out your smart phone with your pediatric application of choice. You begin to write down doses and sizes on your tape on your leg based on the report of the patient’s weight from the providers on scene.
You land in an elementary school parking lot to the delight of the children at the local school. Cars begin to slow and pull over as you exit the helicopter and walk to the squad. You walk to the side door of the ambulance and find 6 EMTs crammed in the squad.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
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!