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7/29/2017

Conference Summary 7/13

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Diabetic foot infections
1) Diabetic foot cellulitis - it comes from ulcers, if there is/was no ulcer, it's likely not cellulitis.
2) Limb-threatening diabetic foot infections - cellulitis extending >2cm from ulcer, probes to bone
3) Charcot foot - occurs in stages, no systemic symptoms, labs will likely be normal. 45% mortality in 4 years.

Orthopedic pearls/orthopedic lab
1) Shoulder dislocations -  anterior dislocations are the most common, and most of those are subcoracoid dislocations.  Least common dislocation is an inferior dislocation - aka luxatio erecta - the arm will be locked in abduction.  
2) Nursemaid's elbow - reduce by supinating the child's forearm with the elbow flexed and apply pressure over the radial head.  You should hear a 'click' as the annular ligament is liberated from the joint.

CIWA
1) Withdrawal seizures - you should not need a lot of benzodiazepines to control alcohol withdrawal seizures.  If the patient requires escalating doses of benzodiazepines to control seizures, consider additional seizure etiologies.
2) CIWA score - it is not diagnostic of alcohol withdrawal, just a severity score.  Diagnose withdrawal based on signs and symptoms in the right context. The patient must be able to participate in questioning as 4 out of the 6 categories necessitate answers from the patient.
 
Dissociated ramblings - attachment from ASA (short read, funny)
1) Achilles ultrasound - sensitivities and specificities vary from paper to paper, however, you can use it to diagnose Achilles' tendon rupture.  One difficulty with tendon ultrasound is a sonographic artifact called anisotropy.  This occurs when the probe is not perpendicular to your higher-than-average refractive structure (ex: tendon) and will cause the structure to appear hypoechoic. 
2) Local anesthetic toxicity (LAST) - the more lipophilic, the more potent the local anesthetic (the uncharged drug must penetrate nerve membrane as well as bind to a hydrophobic site on the sodium channel).  If systemic toxicity occurs, you can consider giving lipid emulsion as a reversal agent.  Lipid rescue is a big area of research in toxicology.   

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  • D&I
  • Residency
    • Chiefs Welcome
    • Residents >
      • Class of 2022 >
        • Brett Bartels
        • Genette Bergman
        • Deven Bhatia
        • Brewer
        • Furgurson
        • Garner
        • Guinn
        • Hayes
        • Jones
        • Marvin
        • Nelson
        • Paladagu
        • Palma
        • Reeder
        • Rodriguez
        • Rogers
        • Rozum
        • Rucker
        • Sulkko
        • Wisbeck
        • Xiong
        • Zakaria
      • Class of 2023
      • Class of 2024
    • Leadership
    • Faculty
    • Committees & Involvement
    • Hospitals
    • Curriculum
    • FAQ
  • Scholarly Activities
    • Research
    • Publications & Abstracts
    • FOAMed
    • Scholarly Opportunities
  • Med Students
    • Rotations
    • Emergency Medicine Interest Group
    • Ultrasound Interest Group
  • Fellowships
    • Simulation
    • Ultrasound
    • EMS
    • Toxicology
    • Pediatric Emergency Medicine
    • Education
    • Emergency Disaster and Global Health
    • Critical Care
  • Interview Season
    • Introduction & Events
    • Dallas Living
    • Dining by Neighborhood >
      • Uptown
      • Knox/Henderson/Greenville
      • Bishop Arts/Oak Cliff
      • Deep Ellum
      • Downtown
      • Oaklawn
    • Outdoors and Family Fun
  • COVID-19
  • Quick Links