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Grand Rounds Recap 2/17/16
morbidity and mortality conference with Dr. Denney
Tracheostomy Exchange/Replacement:
Dealing with tracheostomies and their associated tubes can be daunting. Keeping a few things in mind can make life much easier. Have a basic familiarity with the components of the trach and have a few questions in mind to ask...
Annals of B-Pod: Approach to the Febrile Infant
Imagine it’s your first moonlighting shift at a small rural community hospital. The nearest referral center for both adults and children is 90-minutes away by ground. The annual census of the emergency department is 15,000 patients per year, of which only 5% is pediatric. There are 2 hours left in your 12-hour shift and your energy is all but spent. You are looking forward to winding down at home after an extremely busy and high-acuity shift when your 35th patient of the day checks in. The patient’s chief complaint is fever. You give yourself an internal fist pump thinking that you’re about to see your 12th viral URI of the day and that you’ll be in-and-out of that room no in time. In the midst of your premature celebration you scan the nursing note and see the age of the patient: 6 weeks…You’re hopes of a quick and easy disposition suddenly melt away leaving you with many more questions regarding this patient’s care than answers…You muster your remaining energy and make your way toward the patient’s room.
Take My Breath Away! Evaluation of Shortness of Breath in the ED
There are many chief complaints in the emergency department that can be less than satisfying (*cough* abdominal pain *cough*). Sometimes such patients end up having a completely benign examination, no significant risk factors found on history, and an encounter that leaves you shrugging your shoulders and telling the patient “bellies will do that sometimes, we don’t always find out why.”
Of course, this is all anecdotal, but the chief complaint on this month’s episode seems to have a more consistent presence of pathology with a wide range of severity. With such heterogeneous pathophysiology we turn to the mind of Dr. Stewart Wright to discuss the initial approach to the patient with shortness of breath (SOB)...