Acute Mitral Regurgitation - acute vs chronic Most common cause of acute: 1. Rupture chordae tendinae due to myxomatous disease, infectious endocarditis, rhemuatic heart disease 2. Rupture papillary muscle due to MI (2-7 days prior) Can get pulmonary edema, cardiogenic shock, mimics ARDS, PNA, difficult exam findings Echo enables you to quantify degree of MR; use color flow doppler echo to evalute for acute MR Persistent Tachycardia
Buergers disease
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Elderly Demented Pt s/p "Fall"
- family hx is the greatest risk factor - increases risk 10 fold - smoking is the most important modifiable risk factor - Triad of pain, hypotension, pulsatile mass = 10% - 60% of patients with ruptured AAA - normal vitals signs - bedside US - sensitivity/ specificity 98% Sore Throat After Intubation
- foreign body - vocal cord laceration - tracheal or esophageal perforation Is that a Pneumothorax > Pneumothorax ex vacu - forms adjacent to atelectatic lobe, results from bronchial obstructions - do not treat with chest tube - relieve but fixing obstruction Case - 7 month old male - hx of complex congenital heart disease
- Be on the same team as the parent - you both want the kid to live - Be aware of the limitations of the members of your team and if things aren’t going well, rearrange things - Be empathetic - If you can’t make it, fake it!
Case 1 - Is that Tube in the Right Place?
Case 2 - Locked-In
The BounceBack Patient The "BounceBack" Patient offers use an opportunity... to either be as foolish as we were before or to make up for previous mistakes. With all patient encounters (whether 1st encounter, 2nd encounter, or 102nd encounter) keep these simple rules in mind:
Basic Tips
Integrity - EM physician integrity is under attack
Hospital system -Hospital is venue to admit and provide tools and tech for doctors to work. -Need hospital based specialists (such as ER physician) -Older system - sign exclusive contract to allow doc to see patients in hospital; hospital provides space and support staff. -Contract holders: Small group, single person, corporation Potential for trouble: Contract holder wants to pay physicians as little as possible, hire the most unqualified physician, and control doctors with ability to fire troublemakers and incur penalties for leaving.
Coercion
Corporate Practice of Medicine
How to protect EM Physicians
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