Tamingthesru
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.
“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>
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!