Deterioration post intubation: DOPES
- Dislodged ETT
- Equipment failure
- Stacked breaths
Consider prone positioning for patients with severe ARDS and refractory hypoxemia
Do not forget nephrolithiasis as a cause of colicky abdominal pain with hematuria
Be wary diagnostic momentum in ED bounce back patients
Review your own images
High Risk EM - Dr.
1. Lawsuits are inevitable, but excellent documentation can make the process much easier for you.
2. One of the first steps is treating people well, large percentage of plantiffs want to teach physician a lesson.
3. Most common and costly area of litigation is related to delayed or missed diagnosis.
4. Consider test you order, if they are needed, but be sure to review all results and follow-up on incidentals.
5. Know the evidence that supports the protocols that you follow in your institution, such as chest pain, and make sure that are supported in the literature.
Case Conference - Dr. Lounsbury
• Cerebral venous thrombosis is a rare and difficult to diagnose cause of headaches
• Risk factors include prothrombotic states, pregnancy, infection, or inflammatory conditions
• Diagnose with CTV or MRV as D-dimer is not sensitive or specific
• Always consider VTE in pregnant patients with leg pain or hip pain
• Pregnant & postpartum patients are at significantly increased risk of VTE
• DVT’s in pregnancy tend to be left sided, proximal, and massive!
1. Emergency medicine is an exciting but still profoundly challenging and taxing field.
2. Identifying core strengths and weakness is critical to personal growth, longevity and overall satisfaction in your vocation.
3. Feedback is focused on actions/behaviors. Use action words and verbs to describe these things, stick to facts, use sensory language (saw heard, touched, etc.). Statisitical information can be helpful if gently (I've seen this happen twice.) One strength, one weakness.
4. Session WILL BE uncomfortable if discussing critical areas of growth and if people are willing to be vulnerable. This is not an attack or a change to "get back" at anyone.
• When your sepsis workup doesn’t reveal a source, continue the search, often times these patients need a surgeon.
• When presented with an acute decompensation after a recent illness, consider it’s complications and treat aggressively.
• Our ED diagnoses set patients in a trajectory, avoid premature closure.
Tox Tips - Dr. Snow
1) Always be able to explain anion gapped metabolic acidosis.
2) Remember K.I.L.R for causes of AG metabolic:
•GI & small pupils = cholinergic
•Old, Deaf, & acidosis = ASA
•Bradycardia, Hypotension, & Elevated BS = CCB
•Acute Hepatic Failure: APAP, Acute Hepatitis, Med list!!!
•Sepsis in pump pt = consider withdrawal
Don't forget the Tox triad for most exposures EKG, BMP, and APAP level