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Thoracic Trauma - Dr. Colucciello

1/26/2017

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​- The “Chest” exam should include:
               Assessment of neck veins
               Search for paradoxical movement (flail)
               Respiratory distress
               Palpation for fractures
               Assessment for unequal breath sounds or decreased vocal fremitus
 
- Needle decompression in the field for presumed tension pneumothorax is indicated when hypotension is present
 
- Two most important studies in the first several minutes of evaluation are CXR and FAST Exam (to include a search for pleural sliding)
 
- Up to 15% of patients with thoracic aortic injuries have a normal CXR
 
- The treatment of traumatic aortic injury may include control of heart rate and blood pressure prior to transfer
 
- Multiple rib fracture in the elderly trauma victim often requires admission to the ICU

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Tracheostomy Emergencies - Dr. Lounsbury

1/26/2017

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  • Recall the DOPES mnemonic for any intubated or trach’d patient in distress
  • Prepare your airway adjuncts when replacing a trach including an elastic bougie, size 6 endotracheal tube, and fiberoptic scope
  • Any late trach bleed should be considered to be a tracheo-innominate fistula (TIF) until proven otherwise. TIFs are often preceded by a sentinel bleed which should not be ignored!
  • Any massive trach bleed should be managed by either hyperinflation of the trach cuff or by manual compression of the tracheo-inomminate fistula. 

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Carolinas Case Conference - Dr. Lounsbury

1/26/2017

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​• Never assume that an airway will be straightforward!! 
• Upper airway edema is a common complication of supraglottic device use and should be expected
• King LT’s can be safely exchanged in the emergency department
​
• Bacterial meningitis has a high incidence of elevated intracranial pressure
• Suspect herniation syndrome in any patient with acute mental status change and meningitis is a potential diagnosis
• Hypertonic saline works rapidly to reduce intracranial pressure without significant downsides

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ICH Update - Dr. Asimos

1/12/2017

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  1. Based on the combined results of INTERACT-2 and ATACH-2, for spontaneous ICH patients presenting with an SBP of 150-220 mmHg, a target systolic blood pressure of 140 mm Hg is safe and can be effective for improving functional outcome.
  2. Based on the PATCH trial, platelet transfusion is not recommended in patients taking antiplatelet therapy prior to onset of spontaneous ICH.
  3. In patients with VKA (Vitamin K Antagonist) associated spontaneous ICH, BP reduction and INR reversal therapy should be initiated promptly and before transfer to tertiary care centers.
  4. In patients with VKA associated spontaneous ICH, the findings of the INCH trial suggest that PCC is better than FFP in normalizing the INR within 3 hours and reducing hematoma expansion at 3 and 24 hours, although those effects on overall clinical outcomes remain unclear.

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Case Conference - Dr. Lounsbury

1/12/2017

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• Any penetrating wound between the base of the neck and the inguinal region is a considered thoracic
• ACLS protocol has little to no role in trauma resuscitation
• Resuscitation can be undertaken for organ donation- make sure to document your rationale
• Consider aortic dissection in all presentations with chest pain with abdominal or back pain
• Aortic dissection is rare however there is an increased risk among cocaine users
• Calcified pericarditis is a form of restrictive pericarditis which can result in right sided heart failure. The treatment of choice is pericardectomy.



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Carolinas Case COnference - Dr. Lawson

1/5/2017

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Case 1:
1. Hyperkalemia may manifest as junctional escape rhythm
2. Do not underestimate dehydration as a cause for AKI and hypotension
3. Don't forget to fill the tank before you squeeze it


Case 2:
1. Absolute Lymphocyte Count can be a poor man's CD4. ALC < 1000 cell/mm3 is predictive of CD4 <200cells/mm3
ALC >2000 is predictive of CD4 >200.
2. Bactrim is the treatment of choice for PCP Pneumonia
3. Steroids are indicated for PCP pneumonia with A-a gradient >35 or PaO2 < 70


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Disclaimer: All original material and images included on this website are the sole property of CMC EM Residency and cannot be used or reproduced without written permission.  Information contained on this website is the opinion of the authors and does not necessarily represent the official opinion of Atrium Health or Carolinas Emergency Medicine Residency. 


For Health Care Providers:  Every effort is made to provide the most up to date evidence based medicine.  However, this content may not necessarily reflect the standard of care and application of material contained on this website is at the discretion of the practitioner to verify for accuracy.


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Department of Emergency Medicine
Medical Education Building., Third floor
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​
  • Prospective Applicants
    • 2020 MATCH
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    • Explore Charlotte
    • Official Site
  • ROTATING STUDENTS
    • Prospective Visiting Students
    • UNC Students
    • Healthcare Disparities Externship
    • Current Students
  • Current Residents
    • Airway Lecture!
    • PGY - 1
    • PGY - 2
    • PGY - 3
    • Simulation Reading
    • Blogs >
      • EM GuideWire
      • CMC ECG Masters
      • Core Concepts
      • #FOAMed
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
    • Board Review
    • Journal Club
    • Resident Wellness
    • Resident Research
  • Top 20
  • Chiefs Corner
    • Schedules >
      • Conference/Flashpoint
      • Block Schedule
      • ED Shift Schedule
      • AEC Moonlighting
      • Journal Club/OBP/Audits Schedule
      • Simulation
    • Individualized Interactive Instruction
    • Evaluations/Interview Season
    • Contact Info
    • Resume Builder