Carolinas Emergency Medicine Residency - CMC COMPENDIUM

Trauma & Pregnancy - Dr. Gibbs

6/25/2015

- Maternal well-being = fetal well-being… resuscitation the mother!!!
- Understand important changes in maternal physiology:
- Increased blood volume
- Decreased respiratory reserve

- Aggressive early management of the ABCs essential
- Thoughtful diagnostic testing that still protects mother and baby
- Placental abruption a risk following both major and minor trauma

CMC Case Conference - Dr. Robertson

6/25/2015

Ruptured Appendicitis:
–Can occur in Toddlers
–Very challenging diagnosis: consider in FUO with GI symptoms

–Factors to consider:
•Younger patient population
•Diffuse tenderness to palpation
•Longer duration of illness

–CLOSE FOLLOW-UP IS CRITICAL

OnLine Medical Direction - Dr. Swanson

6/12/2015

Medical Direction

Providers work under the Medical Director's medical direction not the Medical Director's license
Medical Director accountable for ensuring qualified personnel providing patient care and evidence-based medical care protocols

Prehospital Provider Medicolegal Risks

#1 MVC
#2 "bad refusals"
Malpractice insurance covers medical control orders when answering radio calls in ED; variable as far as coverage for care provide "on the streets" beyond any applicable state Good Samaritan statutes

EMTALA with respect to EMS

Triggered when EMS personnel (or patient) asks for ED "help"
For hospital-based EMS systems triggered when EMS contact is made with the patient
For interfacility transports, the referring physician is responsible for selection of the mode and crew to complete the patient transfer and is responsible until the patient arrives at the receiving facility

Air Medical Transport

Multiple factors related to air vs. ground transport:

Distance
Out of hospital time
Environmental conditions
Availability of ground (or air) resources to complete the transport in a timely manner
Crew configuration
Specialized equipment needs
NOT perceived risk of one form of transport vs. another. DOES THE PATIENT NEED TO FLY?

Consider fixed-wing transport in appropriate long distances transports

Pediatric UTI - Dr. Reynolds

6/11/2015

1.       Every fever does not require a urine screening test.

2.       UTI= pyuria plus >50,000 CFU single organism

3.        UTI becomes the diagnosis when the culture is available. We start antibiotics based on the results of the screening UA. Follow up is needed.

4.       Choose antibiotics by resistance patterns and not your favorite PEM attending.

5.       Renal scars are a long term consequence of pyelonephritis. Whether we can prevent scarring remains uncertain.

Skin Cancer - Dr. Kopriva

6/11/2015

1) Three main skin cancers: Basal Cell Carcinoma, Squamous Cell Carcinoma, and Melanoma.
2) Basal cell carcinoma is the most common type at 70-80% of skin cancers.
3) Skin cancers cause emergencies of the airway with obstruction, GI tract with obstruction and perforation, bleeding with carotid blowout syndrome, and pain with bony, nerve, and soft tissue metastases.
4) If you're not a dermatology wizard, use VisualDx to aide you and refer them to a dermatologist.

Carolinas Case Conference - Dr. Nichols

6/4/2015

Prior to discharging any patient, induce a diagnostic pause and ask if your MDM makes sense....have you reasonably explained the complaint?
Pericardial effusions both large and small can be problematic based on their timing and acuity. Use ultrasound to characterize!
Remember, low voltage on EKG--> Check for electrical alternans!

Be sure to anticipate not only the difficult airway, but also the rapid desaturation
Document adequate preoxygenation techniques when applicable
Ensure the team around you is aware of your airway plan and backups

Toxin-induced dysrhythmias: Playing outside of the ACLS sandbox - Dr. Kerns

6/4/2015

The mechanisms of toxin-induced malignant cardiac dysrhythmia often differs from that of coronary artery disease related dysrhythmia: All V-tach is not the same.
It follows that the treatment (both pharmacological and non-pharmacological) may differ from established ACLS algorithms for toxin-induced cardiac dysrhythmias.
Potential therapies include hypertonic bicarbonate, lidocaine, lipid rescue, beta-blockers, benzodiazepines, and ECMO.

Intussusception & Change in MS - Dr. Lessmeier

6/4/2015

1. Intussusception is the most common cause intestinal obstruction in infants between 6 and 36 months of age.

2. It usually presents with intermittent abdominal pain and sometimes vomiting, however lethargy or altered mental status can be the initial presenting sign.

3. In any infant or child presenting with altered mental status, think of intussusception as possible etiology.

4. In stable patient with no signs of perforation who has signs of intussusception, nonoperative reduction is recommended.

5. Surgical treatment is the primary intervention for patients who are unstable or have evidence of perforation.