Tamingthesru

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

“I Don’t Care What You Say. I’m Out of Here Doc…”

You take a big breath and walk out of the SRU.  After having just spent the last hour and a half caring for a hypotensive, actively vomiting variceal bleeder, a full arrest that you had to pronounce, and a GSW to the chest that went quickly to the OR, you are dreading to see the state of your Pod.  As you are just about to sneak into your workstation to get your bearings, you’re flagged down by Mr. Finch, the patient in bed 2.

“What can I help you with sir?” <you>

“What do you mean, what can you help me with?  Man just get my paperwork and let me get out of here.  I’ve had it with this place.  I’m tired of being a pin cushion and I’m not going to take this crap anymore.” <Mr. Finch>

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

Grand Rounds Recap 1/7/14

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!
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Grand Rounds, Intern Radiology Videos Jeffery Hill, MD M.Ed Grand Rounds, Intern Radiology Videos Jeffery Hill, MD M.Ed

Right Upper Quadrant Ultrasound

You are talking to your new patient, John.  He's a pleasant 30 year old man who, by your estimation appears to be a victim of HGS... Holiday Gluttony Syndrome.  John presented to you in the ED with abdominal pain, nausea, and vomiting.  He goes on to tell you all this started after he chowed his way through a few too many Buckeyes.  You see every Christmas, his mom sends him a far too large tin of Buckeye candies, which John had eagerly eaten and eaten and eaten, until the belly pain hit.

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