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Carolinas case conference - Dr. S. Pecevich

7/13/2017

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Picture
Internal Hernias
  • With patients status post gastric bypass, beware of the internal hernia and have low threshold to consult gastric bypass surgeon in abdominal pain!
  • CT scan may fail to reveal internal hernia in up to 20% of cases, and the diagnosis can be missed on initial read.
  • Abdominal pain in pregnancy? There’s more than just the uterus, so remain vigilant and keep a broad differential.
  • Be wary of sending people home after repeat IV pain medication.
 
Osteomyelitis, MSSA bacteremia and pediatrics
  • No great single test to diagnose osteomyelitis--keep a high index of suspicion.
  • In pediatrics, lactate can be unreliable and should be used to rule in, not rule out.
  • Pediatric populations can decompensate quickly, and a normal BP is likely the last vital sign to go in setting of shock. Track perfusion, as skin mottling, AMS and urine output will change before the patient’s BP will.
  • MSSA toxic shock — PVL is a toxin seen in MSSA osteomyelitis with high morbidity.
  • Vancomycin should be used as initial antibiotic when concerned for staph bacteremia. Vancomycin over Clindamycin -- May be up to 30% MRSA clindamycin resistance in Charlotte area,

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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
    • Prospective Visiting Students
    • UNC/Wake Forest Students
    • 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