Tamingthesru

Grand Rounds Jeffery Hill, MD M.Ed Grand Rounds Jeffery Hill, MD M.Ed

Grand Rounds Recap - 11/13/14

SBIRT (Screening, Brief Intervention, Referral, & Treatment) for Substance Abuse

Why should we care?

  • Prevalence of this disease is impressive with greater than 33,000 deaths attributed to alcohol in 2012 alone (287,000 MVC's in Ohio alone attributable to alcohol)
  • Medical problems attributable to alcohol use costs the US $100,000,000,000 annually (from health care bills to lost productivity)!
  • Approximately 33% of inpatient admissions in a country hospital population were attributable to alcohol
  • One in five Americans can be defined as at risk drinkers
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Grand Rounds, Intern Radiology Videos Jeffery Hill, MD M.Ed Grand Rounds, Intern Radiology Videos Jeffery Hill, MD M.Ed

Interpretation of Ankle Radiographs

A 43 year old female presents to the ED after "rolling" her ankle while gardening.  She states that she was stepping down on a shovel when her ankle rolled.  <She describes to you and inversion type injury.>  Being a diligent, studious physician, you quickly run through the Ottawa Ankle Rules while you obtain the remainder of you history and physical.  She was unable to bear weight immediately after the accident and is, likewise, unable to do so here in the ED.  She has no pain with palpation over the medial malleolus but does have significant pain and tenderness with palpation of the lateral malleolus.  You quickly decide that this patient will need ankle radiographs to further investigate the possibility of fracture.  

But, what views should you order? And, once you get the films back, how do you interpret them.  Check out the excellent video embedded below, made by Dr. Claire O'Brien, PGY-1 in the University of Cincinnati Dept. of Emergency Medicine Residency Training program, to find out!

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Grand Rounds Jeffery Hill, MD M.Ed Grand Rounds Jeffery Hill, MD M.Ed

Grand Rounds Recap - 11/5/14

Background of the simulation: eclamptic seizure leading to cardiac arrest

  • Eclampsia should be high on the DDx of seizure for women of child bearing age without past history of seizures
    • Eclampsia typically follows the 1/3 rule: 1/3 occur after 20 weeks gestation, 1/3 occur antepartum, and 1/3 occur postpartum (up to 4 weeks)
    • Be aggressive about seizure management with benzodiazepines and use magnesium (4-6g MgSO4 IV over 10 minutes, followed by a drip for neuroprotection)
    • Follow magnesium levels clinical using reflexes and respiratory rate
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