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

Vascular Ultrasound - Aorta & Lower Extremity Veins

It's a frosty Easter morning and the ED is "q!&%t," all except for the 2 patient's turned over to you by the night ranger.  You greet the first patient, a 75 yo M complaining of flank pain - probably a kidney stone you think to yourself as you walk in to the room.  Walking into the room, you see the patient rolling around on the stretcher (as one would expect from those with a stone jammed in the UVJ), but something about his presentation strikes you as odd - a bit of diaphoresis, clammy pale skin.  It could just be pain, but the specter of a ruptured abdominal aortic aneurysm still looms large in your differential diagnosis.  You quickly exit the room, grab the ultrasound machine and head back in to take a look at his aorta...

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Air Care Orientation Curriculum, Prehospital Medicine Jeffery Hill, MD M.Ed Air Care Orientation Curriculum, Prehospital Medicine Jeffery Hill, MD M.Ed

Flights - A Blow to the Head

You’re working as the Pod-Doc, having just taken the radio from the off-going UH-doc, you just finish admitting the patient in C40 for NSTEMI when the tones go off.

“Air Care 1 and Pod Doc respond to a scene for motorcycle crash, Northern Kentucky”

You call the B-Pod attending, sign out the pod, grab the blood from the blood cooler and head to the helipad.  Flying over the river, landing at a local firehouse’s parking lot you hop out of the back of the helicopter and head to the awaiting squad.

Your patient is a 29 year-old male who was riding his motorcycle (without a helmet) on a local country road.  Coming around a blind corner he unexpectedly found a car stopped in the middle of the road.  Striking the car from behind at ~35mph, he flew over the handlebars and impacted the back of the car.

On EMS’s arrival he was initially unconscious, but since their arrival has become increasingly combative

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

Grand Rounds Recap - 3/25/15

Mortality & Morbidity Conference with Dr. Bohanske

Remember that sometimes the thing a patient needs most is a specialist (i.e surgeon), especially trauma patients

  • Sharps in hectic situations, such as any resuscitation, are dangerous not just for the patient but also for providers as this is one of the most common situations leading to bloodborne pathogen exposures
  • Remove sharps from the field anytime you do not need them and always be responsible for your own sharps to keep your team safe
  • Keep in mind that early predicators of hemorrhagic shock are pulse and mental status/anxiety as BP changes are later indicators
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