Carolinas Case COnference - Dr. NIchols

Tuberculosis
-Immediately isolate any patient that you believe may have TB, and document that you have done so!
-Upper lobe pneumonia should always prompt further consideration of tuberculosis, screen with risk factors
-Patients with TB often have multiple ED visits with active disease, risk factors are often overlooked in triage
-Remember, PPD and IFN blood testing is for latent TB only and will not help you diagnose active TB
-Involve infectious disease, ensure that the health department is involved in the patient's case

Elderly Falls - Missed Femoral Neck Fracture
-95% due to falls, more than 300k admissions per year
-One year mortality in those over 65: 12-37%
-High risk of malunion, poor healing, and avascular necrosis if missed
-Surgical repair is performed as soon as medically stable for procedure
-Range all joints, low threshold to image
-Before discharge, consider home/social factors
-For a full reassessment, ambulate the patient personally or with the nurse to prevent missed injuries and assess feasibility of discharge


High Pressure Injuries
-Surgical emergency despite benign exam
-Paint/grease guns, pressure washers
-Material rapidly spreads to tissue spaces and can cause compartment syndrome
-Time Sensitive: Amputation rate 38% within 6 hours, 58% after that
-EMS transportation if transferring for ortho evaluation from OSH/Urgent Care

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