Tamingthesru
Grand Rounds Recap 12/16/15
"IN JEOPARDY", AN ACS REVIEW - DR. FERMANN
EKG Changes
- According to the AHA, there are no diagnostic EKG changes for NSTEMI
- ST elevations in II, III and aVF with depression in V2 represents and inferior-posterior STEMI
- ST depressions in the precordial leads may represent posterior MI
- Continuous ST segment trend monitoring may pick up very dynamic ischemic changes (though this is almost never done anymore)
Annals of B-Pod: An Ocular Emergency
A Case of Retrobulbar Hematoma
The patient is a female in her 60s who presents by EMS after a fall in a parking lot approximately one hour prior to arrival. She fell forward and landed on her face. She believes she simply tripped and fell, but she did lose consciousness and does not know how she ended up on the ground. Per family, she is unsteady on her feet and falls frequently, requiring a cane at baseline. She reports feeling “weak” but no other symptoms preceding her fall. She presents with significant right-sided facial trauma and is unable to open her right eye. She has no complaints of blurry vision in her left eye. She has no headache or other areas of pain or trauma.
Dazed and Confused: The Approach to Altered Mental Status in the ED
We will all have the experience of taking care of a patient in the emergency department who is acting…different than they normally do. Sometimes, the change can be subtle, maybe a family member will be the first to notice and bring the patient to be evaluated. Sometimes the patient makes the change abundantly clear. In either case it is essential to identify the underlying cause and treat any emergent conditions precipitating this dysfunction of the brain. This month we hear from Dr. Erin McDonough on her approach to the patient with altered mental status (AMS).