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Grand Rounds Recap 11.1.23
This week Grand Rounds kicked off with a range of complicated cases including of choledocholithiasis, syphilis, and hyperthermic-associated toxidromes. Dr. Bryant than presented on burns in a low resource setting for our global health lecture. Drs. Goel and Thompson discussed the decision rules for head and C-spine imaging. And Drs. Gallen, Brower and Finney finished off our resident lectures for our core content.
Serratus Anterior Plane Blocks for Rib Fractures in the ED
Rib fractures occur in up to 10% of all traumatically injured patients and these fractures are frequently associated with respiratory complications such a pneumonia. In the ED, our typical protocol to decrease the incidence of these respiratory complications is early initiation of aggressive pain control and pulmonary hygiene. These patients often will receive systemic analgesia with opiates to decrease the incidence of these respiratory complications, which leads to its own set of opiate associated-complications, including constipation, delirium and dependence.
Sound Waves for Shoulder Dislocations
Shoulder injury and dislocations are common reasons for patients to present to the emergency department (ED) for evaluation. As ED physicians we often must determine whether the shoulder is fractured, dislocated, or both. Most of the time this is done through the use of physical examination in addition to the use of a plain film radiograph of the shoulder.
The use of ultrasound in the diagnosis and management of musculoskeletal injuries is becoming more common. While it currently does not supplant the use of radiographs, it can be a useful adjunct to the management of these patients.