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Grand Rounds Summary 10.18.17
This week Dr. Gottula gave us a great in-depth explanation into alloimmunization and the use of RhoGAM in the ED. Dr. Owens and Faryar participated in a CPC centered around a sickle cell patient with knee pain. Dr. Asghar from orthopedics discussed the management of spine fractures in the ED. Our visiting professor Dr. Gail D'Onofrio discussed the ongoing opioid abuse issues facing the country. Dr. Hall discussed industrial injuries while Dr. Polsinelli wrapped things up with a discussion about how to use EMR to report core measures.
Rh-D Alloimmunization Prevention in the Emergency Department
The risk of alloimmunization in pregnancy is one the EP faces every day, but what are we preventing? when do we need to consider increasing our RhoGAM dosing? and do you really need a type and screen for the same patient in the same pregnancy? Dr. Gottula gets to the bottom of the type and screen and presents a rational algorithm for working up the Rh status of the pregnant patient in the ED.
Grand Rounds Summary 3/2/16
OB-GYN Emergencies with Dr. McKinney
Case 1: 18 wk patient with vaginal spotting who is Rh- but antibody+
Bedside U/S shows fetal abnormality due to Rh alloimmunization with fetal hydrops. Positive antibody screening on gravid female should warrant obstetric consultation. Rhogam administration within 72 hours of bleeding is important.
Case 2: 40 wk female with gestational DM present with crowning fetus who fails to immediately deliver secondary to shoulder dystocia.
Treatment: stop pushing and avoid traction. Initially attempt hyperflexion of legs and suprapubic pressure to release (McRoberts maneuver). Then consider episiotomy because subsequent maneuvers involve twisting the baby to get shoulder into a different plane.