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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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Picture

  • 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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  • RESIDENCY
    • About CMC
    • Curriculum
    • Benefits
    • Explore Charlotte
    • Official Site
  • FELLOWSHIP
    • EMS
    • Global EM
    • Pediatric EM
    • Toxicology >
      • Tox Faculty
      • Tox Application
    • (All Others)
  • PEOPLE
    • Program Leadership
    • PGY-3
    • PGY-2
    • PGY-1
    • Alumni
  • STUDENTS/APPLICANTS
    • Medical Students at CMC
    • EM Acting Internship
    • Healthcare Disparities Externship
    • Resident Mentorship
  • #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