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Carolina Case CONFERENCE - Dr. West

4/28/2016

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Retained Foreign Body
  • X-ray or US if mechanism involves glass or is high risk
  • Consider retained FB if wounds not healing well
  • US will demonstrate wooden foreign bodies
  • Common cause for EP to be sued
 
Ectopic pregnancy
  • 2 % all pregnancy are ectopic in location – increasing risk if history of ectopic
  • 9% will present with only painless vaginal bleeding
  • Can be associated pseudogestational sac
 
Mushroom induced hepatotoxity
  • Most common Amanita ingestions
  • Consider in new immigrants to the US who present with acute liver injury
  • Consult your local toxicologist, treatment can include silibinin, NAC, high dose PCN, and ultimately possible liver transplant

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Pediatric Case COnference - Dr. Lawson

4/26/2016

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Abdominal Pain of Unusual Cause
  • Abdominal pain in children is not always AGE, appendicitis, or UTI - keep your differential broad and use your exam skills (including GU and Tanner staging)
  • "Smokiness" on ultrasound may be due to blood (RBCs scattering sound waves) or stasis
  • Hematocolpos as a result of imperforate hymen can cause abdominal pain and urinary retention

PE vs Sepsis
  • PE is a rare occurrence in children and often presents atypically (classic symptoms often only present in large PEs)
  • Adult clinical decision rules (Wells Criteria and PERC) do not reliably apply to children
  • Obesity, OCP use, and previous thrombus (not PE) are the three leading risk factors for PE
  • History of central venous line is the most important predisposing cause of DVT
  • Several studies other than CTA can help lessen your suspicion for PE (CXR, EKG, cardiac echo, extremity DVT US, BNP, troponin)
  • Sepsis in children can be subtle and precipitous

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Pediatric ECGs - Dr. Bryant

4/21/2016

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  • Normal Peds EKG Variations
    • Right heart dominance 
      • From infancy to adulthood ventricular dominance transitions from a relatively thicker RV in utero/infancy to thicker LV as adults
      • Right axis deviation 
      • Tall R waves in V1-V3
      • RSR' in V1
      • Deep S waves and Q waves in lateral leads
      • Juvenile T wave pattern in V1-V3
    • Small cardiac size = shorter intervals, faster rate
    • J-point depression
    • Early repolarization
    • Sinus arrhythmia
​
  • NOT Normal Peds EKG Variations
    • Brugada Syndrome
      • EKG: Leads V1-V3
        • RSR’ with ST elevation
      • 3 Types
        • Type 1 – coved
          • Diagnostic
        • Type 2/3 – saddle-back
    • Arrhythmogenic Right Ventricular Dysplasia (ARVD)
      • EKG: Leads V1-V3
        • Epsilon waves
        • Inverted T waves
    • Catecholaminergic Paroxysmal Ventricular Tachycardia (CPVT)
      • EKG:
        • Normal baseline, bidirectional QRS polymorphic Vtach with exertion/excitement
    • Hypertrophic Obstructive Cardiomyopathy (HOCM)
      • EKG: Lateral leads
        • Dagger-like deep narrow Q waves
        • Deep narrow T wave inversions
        • +/- LVH, left axis deviation
    • Wolff-Parkinson-White (WPW)
      • EKG:
        • Delta waves
        • Wide QRS
        • Short PQ segment
    • Anomalous Left Coronary Artery from the Pulmonary Artery (ALCAPA)
      • EKG:
        • Anterolateral ischemic changes
        • Lateral leads
          • Deep wide Q waves
          • T wave inversions
    • Long QT Syndrome
      • EKG:
        • QTc > 450ms
        • At risk for Torsade de Pointes/Vtach

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Pediatric Syncope - Dr. Bryant

4/21/2016

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Pediatric Syncope Algorithm
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Appendicitis - Dr. Craig

4/15/2016

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Picture
  • ​The classic presentation of appendicitis is seen ~50% of the time. 
  • There are several well-known atypical presentations that are commonly misdiagnosed at the initial encounter. 
  • The common theme is that symptoms are NOT localized to the right iliac fossa. 
  • Know these atypical presentations so that you can nail the diagnosis:
               ·         Young healthy male with cystitis symptoms
               ·         Toddler with a RLE limp
               ·         Infant with inflamed right hemiscrotum
               ·         Pregnant female with right flank pain, pyuria
               ·         Right sided truncal cellulitis
               ·         RUQ discomfort with normal RUQ ultrasound
               ·         Urinary retention
​


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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. 


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Department of Emergency Medicine
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​
  • Prospective Applicants
    • 2020 MATCH
    • About CMC
    • Our Curriculum
    • Our Residents
    • Our Fellowships
    • Program Leadership
    • 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