Tamingthesru
Approach to Reading MRI of the Spine
It's another back pain type of day in Minor Care. 3 hours into your shift and you've seen 6 patient's with back pain. You quickly evaluate them asking them about red flag symptoms, searching for signs of neurologic injury on your physical exam. As you talk to Jane, your next patient, you get worried she doesn't have simple musculo-ligamentous back pain. Jane has a history of IVDU and states her last use was 3 months ago. She cites some subjective fever and chills over the past several days along with aching low back pain which has been getting steadily worse. On exam, you find she is febrile with a temperature of 101.4, tachycardic to 110, with a normal blood pressure. She has midline upper lumbar and lower thoracic spinal tenderness to palpation.
Grand Rounds Recap - 1/21/15
Evidence-Based Emergency Medicine: Accidental Hypothermia with Drs. Mudd & Riddle
Grading the Severity of Hypothermia
- Mild hypothermia is defined as 32-35 °C and symptoms include confusion and diuresis
- Moderate hypothermia occurs from 28-31°C and is associated with lack of shivering, atrial arrhythmias, and worsening changes in mental status (including paradoxical undressing)
- Severe hypothermia happens when core body temperature is less then 28 °C and is associated with coma, significant decreases in metabolism, and a very low threshold for V-fib
Grand Rounds Recap - 1/14/15
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.