Leave it to Dr. Sam Antar to keep a topic light, elegant, and entertaining while still very educational. Thanks for a great Senior Grand Rounds!
In our last Senior Grand Rounds, Dr. Colton Langridge discussed transplant emergencies. Check out his picture summary below. Next up will be Dr. Sam Antar.
The MegaShelter is scheduled to demobilize this week after a huge contribution to the community affected by Hurricane Harvey. Huge thanks to all the volunteers and our disaster team. So far, there have been over 2500 patient encounters at the facility.
In a new series from AliEM, chief residents combined to help improve splinting and orthopedic care in the ED. Including contributions from our very own Dr. Hockstein, this should be a great guide to your orthopedic care. Click the image to check it out.
Max continues his weekly conference summaries. Below is the abbreviated version (edited by our webmaster)
1) Fever - only 50% of transplant patients with infection have fever, don't rely on fever!
2) Rejection rates - kidney 20%, heart and lungs 30%, liver 66%
1) Supraclavicular CVC -The landmark for needle insertion is posterior to the clavicle at the middle/medial third (point needle towards the ipsilateral sternoclavicular joint)
2) US-guided vs landmark guided CVC placement - 12% reduction in unsuccessful line attempts and 71% fewer IJ complications when US is used over a blind technique.
Developing world EM
1) Congenital hypothyroidism - failure to meet developmental milestones, thickened skin, increased abdominal girth, and macroglossia.
2) Conjunctival suffusion - red conjunctiva without inflammatory exudate. Seen in Weil's disease (severe Leptospirosis). Treatment(like any other weird disease) is doxycycline and/or penicillin G.
3) Scrub typhus -Transmitted by mites, presents with rapid onset fever, headache, altered mental status, and inoculation eschar. Again, doxycycline.
1) Ultra-simple Brugada criterion - R wave to peak time (RWPT) of > 50ms predicts ventricular tachycardia.
2) Unclear regular wide complex tachycardia origin - when in doubt, treat as ventricular tachycardia!
1) Torsades de Pointes - for polymorphic VT from long QT syndromes, after Magnesium, consider overdrive pacing and chronotropic support (isoproterenol, epinephrine).
3) Propofol infusion syndrome - acute refractory bradycardia and eventual asystole in patients on >4mg/kg/hr for two days in the presence of metabolic acidosis, rhabdomyolysis, hyperlipidemia, and fatty liver. Max continues his weekly conference summaries. Below is the abbreviated version from our webmaster.