We all know that Flank Pain and Hematuria = Kidney Stone. Right?
First Time Flank Pain
10-30% of patients, when CT scan obtained, had an alternative diagnosis (even with good pre-test probability for kidney stone)
Repeat Renal Stones
8 day old with Respiratory Distress, Mottling, and Hypoxia
Very Broad and includes terrible potential problem. Keep the following in mind!
2 year old s/p Fall
Fall not witnessed
Fussy initially, then baseline
Blood tinged emesis x 1
Neuro exam unremarkable
To CT or Not to CT?
Minor Head Injury Rule - see PedEMMorsel
Documentation = Communication
Review of Systems Pointers
Avoid cloning notes, document what you do and that will suffice.
-Focal neurologic deficit
-History of spinal instrumentation
-Duration longer than 6 weeks
Crotalid Envenomations Dr. Beuhler
Important steps in management of bite care:
Don't just treat lab abnormalities
a. Crofab = 10cc/hr; 4 vials & reevaluate after 1-2 hrs.
Remember crofab interrupts coagulopathy & helps lower compartment pressures & possibly helps with pain - it will NOT stop or reverse local tissue destruction
If you DC home have follow up in < 24 hrs for wound reevaluation
II - Cricoid to angle of mandible
III - Angle of mandible to base of skull
*Zone II is more easily evaluated by surgical intervention; zones I and III by
a. Corneal staining, Increased pressure and acute glaucoma, Rebleeding
2. Globe rupture - DO NOT MEASURE PRESSURES
3. Medial canthus injury - think about damage to lacrimal duct
I. Fracture line passes through the alveolar ridge, lateral nose and inferior
wall of maxillary sinus.
II. Fracture arch passes through posterior alveolar ridge, lateral walls
of maxillary sinuses, inferior orbital rim and nasal bones
III. Fracture line passes through nasofrontal suture, maxillo-frontal
suture, orbital wall and zygomatic arch.
2. Mandibular Fractures - things to look for:
a. Sublingual hematoma (pathognomonic), malocclusion, tongue depressor
test (pain with biting down), limited mouth opening, mental nerve
3. Auricular Hematoma & septal hematomas - drain to avoid pressure necrosis
and cauliflower ear & saddle nose deformity respectively
2. Loss of aortic knob
3. R mainstem bronchus misplaced
4. Apical cap
5. Tracheal deviation
6. L pleural effusion
2. Jefferson's Fracture - fracture through posterior & anterior arches of C1 > caused by axial loading - the ring breaks outward
3. Pseudosubluxation - normal mobility of C-2 on C-3 in flexion which be mistaken for pathologic motion; (is normal in children < 8 years old);
4. When managed properly SDH = greater morbidity than epidurals