Carolinas Case CONFERENCE - Dr. Lawson

Case #1: Posterior MI
1. Posterior MI is suggested by ECG clues in V1-V3. Look for tall broad R waves, R:S > 1, horizontal ST depressions and upright T waves

2. Recall that when posterior MI occurs as an extension of existing inferior MI the hemodynamic consequences can be significantly more pronounced

3. Obtain posterior leads V7-9 to confirm suspicion of posterior STEMI

Case #2: Mesenteric Ischemia
1. The diagnostic test of choice for ischemic colitis is a colonoscopy.

2. Beware the elderly patient with abdominal pain. 25-33% will require operative management during admission. Mortality rate is high.

3. Do not hesitate to call radiology to further discuss equivocal imaging reads.

Case #3: Burn
Critical actions for management of burn patients:
A. Protect the airway
B. Classify type/depth/extent of burns (Rule of 9's)
C. Fluid resuscitate (Parkland formula, to start with... but need to adjust for urine output)
D. Control pain
E. Prevent infection
F. Ensure timely disposition to appropriate level of care

G. When transferring patients to burn center, dress thermal burns in sterile dry gauze 

H. All children with burns should have thorough eval for possible NAT