Tamingthesru
Grand Rounds Recap - 12/18/14
Morbidity and Mortality Learning Points with Dr. Stull
1. Should Post-ROSC patients get cardiac cath?
- Cardiac arrest patients who have STEMI on EKG after ROSC tend to have good outcomes (overall survival and intact neurologic survival) if they get cath'ed.
- According to latest Australian study (all patients with ROSC from OHCA, not STEMI) OR for overall survival is 2.77 and OR 2.2 for good neurologic outcome
- VT/VF cardiac arrest patients who do not have a STEMI on EKG: improved survival and likelihood of good neurologic outcomes if cath'ed within 24 hours.
- Our cardiology department wants all post-ROSC VF/VT patients to have cath lab activation. All other post-ROSC cases, call cardiology to discuss need for cath lab
- All post-ROSC STEMI should go to cath lab no matter what their neuro status is
Interpretation of Hand & Wrist Radiographs
You knew that you'd see at least one patient with a FOOSH (Fall On Outstretched Hand) while working in Minor Care. A nice, thin layer of ice laid down by the "Snow-pocalypse" snow storm that came through last night had already caused several patients to slip and fall.
John, your first patient of the day, a 24 year old rushing to work this morning, slipped coming down the steps outside his house. He tells you he landed on his right hand with his arm extended at the elbow and wrist. He is complaining of pain in the dorsal and radial right wrist. You go to examine him, noticing no obvious deformities, lacerations, or abrasions. On palpation, he has tenderness to palpation in the anatomic snuff box and pain with axial loading of the thumb. Suspecting a scaphoid fracture, you order a wrist x-ray.
While waiting for the film to be developed, you look for a refresher on how to interpret these challenging films.