CMC COMPENDIUM
  • RESIDENCY
    • About CMC
    • Curriculum
    • Benefits
    • Explore Charlotte
    • Official Site
  • FELLOWSHIP
    • Global EM
    • Toxicology
    • (All Others)
  • PEOPLE
    • Program Leadership
    • PGY-3
    • PGY-2
    • PGY-1
    • MATCH 2022
    • Alumni
  • STUDENTS/APPLICANTS
    • Prospective Visiting Students
    • Healthcare Disparities Externship
    • UNC/Wake Forest Students
  • #FOAMed
    • EM GuideWire
    • CMC Imaging Mastery
    • Pediatric EM Morsels
    • Blogs, etc. >
      • CMC ECG Masters
      • Core Concepts
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
  • Chiefs Corner
    • Top 20
    • Current Chiefs
    • Schedules >
      • Conference/Flashpoint
      • Block Schedule
      • ED Shift Schedule
      • AEC Moonlighting
      • Journal Club/OBP/Audits Schedule
      • Simulation
    • Resources >
      • Fox Reference Library
      • FlashPoint
      • Airway Lecture
      • Student Resources
      • PGY - 1
      • PGY - 2
      • PGY - 3
      • Simulation Reading
      • Resident Wellness
      • Resident Research
      • Resume Builder
    • Individualized Interactive Instruction
    • Evaluations/Interview Season

Case COnference - Dr. King

4/30/2015

0 Comments

 
Picture
Pediatric Cervical Spine Injuries

Anatomical considerations include:
- Head-to-body ratio significantly larger than adult patients
- High ligamentous laxity, underdeveloped paraspinous muscle development
- Increased force on fulcrum between axial spine and skull

Rare but dangerous: seen in less than 1% of pediatric blunt trauma

2011 PECARN Annals article lists 8 risk factors:
- High mechanism, diving injury, AMS, focal neurologic deficit, neck pain, torticollis, major torso injury, predisposing factors


Sepsis Masquerade

-       Remember that an elevated lactate does not equal sepsis 
-       Lactic acidosis spawns an extensive differential 
-       The Emergency Department is high risk for medical error

o   Are you anchoring?
o   Will your diagnostic inertia negatively affect your patient?
o   Is premature closure limiting your differential?

-       
Remember to take your diagnostic pause 
0 Comments

Spontaneous Bacterial Peritonitis - Dr. Jyothindran

4/30/2015

0 Comments

 
Spontaneous Bacterial Peritonitis
- defined as infection of ascitic fluid with no obvious surgically removable source
- high mortality - 40% at first onset, 70% two year mortality
- usually caused by translocation of gut bacteria, GNBs ( E Coli) or GPC (streptococcus sp. etc)
- Consider in ALL cirrhotics! 
- Check for ascites with U/S if you have to.

Abdominal Paracentesis:
- Paracentesis has very low 5% risk of bleeding which can be avoided by ultrasound
- Only 0.6% risk of infection from bowel injury during the procedure or iatrogenic introduction
- Fluid Labs: order protein, count, gram stains and culture
     -The count is what counts. % segs  x total nucleated cells = absolute PMN count > = 250 cells per mm3
     -gram stain is highly inaccurate with 40 % FP rate
     -culture is also only positive 40 % of the time
     -culture negative neutrophilic ascites and SBP should be treated the same

Treatment:
- Antibiotics : Ceftriaxone 2g per day or Cefotaxime 2g per 6 h
- Albumin : 1.5 g/kg in first six hours and 1 g/kg on day 3

Renal Dysfunction:
- high correlation with mortality
- hepatorenal syndrome - type 1 is acute and more lethal
- Reduction in mortality from 29% to 10% with use of albumin

SBP Prophylaxis : in GI bleeders, those with previous SBP and also those with low protein ascitic fluid  and no history of SBP
0 Comments

Acute Mesenteric Ischemia - Dr. Yang

4/30/2015

0 Comments

 
Picture
1.  Keep a low threshold for CT scanning in elderly patients with abdominal pain.
2.  Cannot rule out acute mesenteric ischemia with labs alone.
3.  Adequate resuscitation and IV antibiotics may prolong reversible ischemia time.
4.  Keep AMI high in your differential diagnosis as mortality approaches 100% if missed.
5.  CTA is much better than CT with IV and PO contrast (95% sensitivity vs. 83% sensitivity) if highly suspected.

0 Comments

Fever and Sickle Cell Disease - Dr. Young

4/16/2015

0 Comments

 
Picture
1. All febrile SCD patients get the same initial work-up: H&P, CBC with diff, retic, and BCX
2. ACS = CTX + macrolide (+/- O2 and blood)
3. ACS more likely to develop inpatient... use good pulmonary toilet to prevent
4. Always check the spleen
5. Disposition criteria: home vs. 24H follow-up

0 Comments

Mediastinal Masses - Dr. Smith

4/16/2015

0 Comments

 
Picture
1. Be wary of atypical respiratory symptoms

2. Don't be afraid of imaging in the right setting

3. If you are concerned about mediastinal mass, image and admit

4. If you have a patient with mediastinal mass and increased work of breathing but they are relatively stable, leave them alone

5. If forced to intervene, try prone position and call for help

0 Comments

Carolinas Case COnference - Dr. Reyner

4/9/2015

0 Comments

 
Picture
Pseudoaneurysms
- Definitions:
    1. Outpouching of a blood vessel, involving a defect in the 2 innermost layers (tunica intima and media) with continuity of the outermost layer (adventitia)
     2.  Alternatively, all three layers are damaged and bleeding is contained by blood clot or surrounding structures
- Etiologies are multifactorial, including post traumatic, iatrogenic (post catheterization), infection and inflammation, IV drug use, septic emboli and MI
-  Clinical Presentation: 
     - Increased swelling which may be pulsatile over site of previous needle puncture, surgery or trauma; Anemia in cases of significant blood loss; significant pain
- Look for characteristic yin yang sign on doppler
- EAST Guidelines in Trauma:
     - Level 2 recommendation: Patients without signs of hard vascular injury who have abnormal physical examination findings and or ABI <0.9 should have further evaluation to rule out a vascular injury
- Consider vascular imaging in patients with delayed (>1wk) bleeding, pain or swelling after a traumatic injury

Hiccups:
- An involuntary, spasmodic contraction of the diaphragm and intercostal muscles.  Diaphragm contraction results in sudden inspiration and ends with abrupt closure of the glottis, generating the “hic” sound
- Thorough history and physical exam is key in patients with persistent hiccups (48h to 1 month)
- Etiology is broad. Most common causes include GI (overeating, gastric distention, GERD); post operative; diaphragmatic processes (subdiaphragmatic abscess). 
- CNS processes are a more serious cause. In patients with neurologic symptoms, consider MRI imaging. Patients with dorsal medullary strokes can have hiccups for up to 1 year that are debilitating and recalcitrant to medications. 


Sign of Lesar Trelat
- Explosive onset of multiple pruritic seborrheic keratoses
- Rapid increase in size and number
- Often have an inflammatory base
- An ominous sign of gastrointestinal carcinomas
- Most commonly pancreatic, stomach, liver, and colorectal 


0 Comments

    Archives

    August 2018
    February 2018
    January 2018
    December 2017
    October 2017
    September 2017
    August 2017
    July 2017
    June 2017
    May 2017
    April 2017
    March 2017
    February 2017
    January 2017
    December 2016
    November 2016
    October 2016
    September 2016
    August 2016
    July 2016
    June 2016
    May 2016
    April 2016
    March 2016
    February 2016
    January 2016
    December 2015
    November 2015
    October 2015
    September 2015
    August 2015
    July 2015
    June 2015
    May 2015
    April 2015
    March 2015
    February 2015
    January 2015
    December 2014
    November 2014
    October 2014
    September 2014
    August 2014
    July 2014
    June 2014
    May 2014
    April 2014
    March 2014
    February 2014
    January 2014
    December 2013
    November 2013
    October 2013
    September 2013
    August 2013
    July 2013

    Categories

    All
    Abdominal Pain
    Abdominal-pain
    Airway
    Back Pain
    Back Pain
    Bleeding
    Change-in-mental-status
    Chest Pain
    Dizziness
    Ecg
    Emboli
    Environmental
    Fever
    Gyn
    Headache
    Hypertension
    Infectious Disease
    Pain
    Pediatric Emergency
    Professionalism
    Psych
    Respiratory Distress
    Sepsis
    Shock
    Toxins
    Trauma
    Vomiting
    Weakness

    RSS Feed

    Tweets by @PedEMMorsels
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.

For the Public:  This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  Relying on information contained on this website is done at your own risk.  Do not disregard professional medical advice or delay seeking care secondary to content on this website.  Call 911 or seek a medical professional immediately for any medical emergencies.
Like us on Facebook or
follow us on Twitter/Instagram

Contact Us:

Department of Emergency Medicine
Medical Education Building., Third floor
1000 Blythe Blvd.
Charlotte, NC 28203

Telephone: 704-355-3658 
Fax: 704-355-7047
​
  • RESIDENCY
    • About CMC
    • Curriculum
    • Benefits
    • Explore Charlotte
    • Official Site
  • FELLOWSHIP
    • Global EM
    • Toxicology
    • (All Others)
  • PEOPLE
    • Program Leadership
    • PGY-3
    • PGY-2
    • PGY-1
    • MATCH 2022
    • Alumni
  • STUDENTS/APPLICANTS
    • Prospective Visiting Students
    • Healthcare Disparities Externship
    • UNC/Wake Forest Students
  • #FOAMed
    • EM GuideWire
    • CMC Imaging Mastery
    • Pediatric EM Morsels
    • Blogs, etc. >
      • CMC ECG Masters
      • Core Concepts
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
  • Chiefs Corner
    • Top 20
    • Current Chiefs
    • Schedules >
      • Conference/Flashpoint
      • Block Schedule
      • ED Shift Schedule
      • AEC Moonlighting
      • Journal Club/OBP/Audits Schedule
      • Simulation
    • Resources >
      • Fox Reference Library
      • FlashPoint
      • Airway Lecture
      • Student Resources
      • PGY - 1
      • PGY - 2
      • PGY - 3
      • Simulation Reading
      • Resident Wellness
      • Resident Research
      • Resume Builder
    • Individualized Interactive Instruction
    • Evaluations/Interview Season