Delivering neonates in the emergency department can be a stressful process, in part due to the potential for serious maternal or infant morbidity. In this article, Dr. Habib will discuss a case of placenta previa and walk us through how to recognize placental pathology, its pathophysiology, and appropriate emergent management.Read More
Dr. McKinney from our MFM service started us off with some pearls of 2nd and 3rd trimester complications and management. Drs Murphy, Liebman, McKee and Whitford taught small groups about tips and tricks of extensor tendon repair, hip ultrasound and compartment pressures. Dr. Hughes gave us a talk on plain film utility in the ED and finally Drs. Scanlon and Doerning faced off in a CPC of a case of HELLP syndrome.Read More
Grand Rounds kicked off this week with Dr. Axelson's final M&M of the year where we learned about hypertensive emergencies, 2nd & 3rd trimester vaginal bleeding, the care of the sick asthmatic, which bronchiolitics can go home and how exactly to treat the many forms of UTIs. Drs. Kircher and Murphy-Crews continued the learning with a case follow-up about intubating patients with airway stents and pediatric head injury, respectively. Our joint EM-Peds lecture rounded out the day with visual diagnoses in peds.Read More
Oral Boards with Dr. Roche
Case 1 - 37 yo F, G3P2, no prenatal care, somewhere around 3rd trimester, presents with vaginal bleeding. She endorses feeling weak and dizzy and had 1 syncopal episode at home. On arrival, she is tachycardic and hypotensive (80s/60s), has cool extremities with weak peripheral pulse. Fundus is a few cm below xyphoid process. On a sterile speculum exam she has a large amount of bleeding and cervix is dilated to 3 cm. US shows IUP with good cardiac activity. She requires blood rescuscitation and admission to OB for delivery due to placenta previa.Read More
Management of the GI bleed (a review of the Cochrane Reviews):
- PPI drips have been shown to decrease the rate of rebleed in patients with known peoptic ulcers. It has not been shown to decrease mortality, hospital stay, transfusion need. It also has not been shown to be beneficial in the undifferentiated upper GI bleed and may have a trend toward harm.
- Octreotide doesn't improve mortality but on average decreased transfusion requirement by 1/2u product.
- Antibiotic coverage (treating for gut translocation with ceftriaxone) has been shown to have lowered mortality from infection and all-cause mortality.
- Prophylactic intubation: 2 retrospective chart reviews came up with contrasting results on mortality outcome after intubating for prophylactic reasons (patient was protecting their airway).