Tamingthesru

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

Grand Rounds Recap - 8/20/14

An Update on CHF w/ Dr. Fermann

The phenotype of acute presentation of heart failure can be dramatically different. Consider the difference between the hypotensive patient who has very poor cardiac output now in cardiogenic shock requiring pressors (these have a very poor outcome), the normotensive patient who has slowly become retained fluid, and the acutely hypertensive patient who presents in extremis (who actually does quite well even though they are so sick on arrival).

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

Grand Rounds Recap - 8/13/2014

R4 Simulation Series: Genitourinary Emergencies with Dr. Moschella and Dr. Verzwyvelt

  • Fournier's Gangrene (ie necrotizing fasciitis of the perineum): Case simulation of 19 yo M with tachycardia, hypotension, altered mental status found to have erythema, induration, and crepitus of the perineum. Initial steps are aggressive treatment of sepsis (broad spectrum antibiotics to cover skin and gut flora as this is commonly polymycrobial) and early surgical debridement. Either Urology of Acute Care Surgery will mobilize to perform the debridement.
  • Oral boards case: Consider ovarian torsion in young female with acute onset pain in lower abdomen or pelvis. You may find adnexal fullness or tenderness on exam. Diagnostic test of choice is transvaginal duplex ultrasound. Remember to include ectopic pregnancy, appendicitis, TOA in your differential.
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Jeffery Hill, MD M.Ed Jeffery Hill, MD M.Ed

Grand Rounds Recap - 8/6/2104

Some of the challenges to think about when performing these procedures in the aircraft include:

  • Positioning: you are stuck at the head of the bed, the patient is packaged, their arms are down to their side, and space is limited.
  • Sharps: high risk of accidental injury when in the back of a squad or in the helicopter. Be careful!
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