CMC COMPENDIUM
  • 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

Small Bowel Obstruction - Dr. Robertson

1/9/2014

0 Comments

 
Picture

Basics
  • Account for approximately 20% of all admissions for acute abdominal pain
  • Mortality approaches 5% for non-strangulated obstructions and 30% for strangulated obstructions
  • 90% with abd surg get adhesions, 25% will develop SBO
  • Causes  to consider = duodenum stenosis, stricture (adhesion, bezoars), gallstone ileus, femoral hernia, parastomal hernia, internal hernia. Also SB volvulus, intussusception (mech in adults)

Type

  •    Mechanical closed loop- twisting, increased likelihood of vascular compromise
  •    Neurogenic- disturbance in movt, ileus. Panc, metabolic disturb, mess, any bowel inflamm, trauma, infection
  •    Pseudo obstruction- decreased motility due to systemic medical condition

Patho
  •     Distention, poor absorption, edema--- intraperitoneal sequestration.
  •     Closed loops- venous congestion, source of hemorrhage - Risk of strangulation dramatically increased with closed loop obstructions

Presentation

  • Intermittent pain, change to constant concern for strangulation (ischemia, perf)
  • Constipation OR diarrhea
  • Difficult to predict strangulation

Risk factors
  • Prior SBO - Greatest risk factor.
  • Abd surg
  • Hernia

Diagnosis
  • Labs generally unhelpful, but help with resusc
  • CT abd specificity = 94, sensitivity = 56  for strangulation

Therapy
  • NPO
  • IVF
  • Antibiotics (?) - depending on severity and possibility of going to the OR
  • NGT (?) - Need to weigh Risks vs Benefits.

0 Comments

M&M - Dr. Keller

1/9/2014

0 Comments

 
Picture
Elderly Demented Pt s/p "Fall"
  • First, define and characterize the "fall" as best you are able. 
  • Be careful focusing only on mechanical issues.  Was this Syncope?
  • Learning point - abdominal aortic aneurysm
        - rare before age 50,
        - family hx is the greatest risk factor - increases risk 10 fold
        - smoking is the most important modifiable risk factor

            - Triad of pain, hypotension, pulsatile mass = 10%
            - 60% of patients with ruptured AAA - normal vitals signs
            - bedside US - sensitivity/ specificity 98%

Sore Throat After Intubation


  • Post intubation sore throat - usually gone by 5th  day -- persistent pain warrants concern.
  • Common traumas
            - dental injury or lip abrasion
            -  foreign body
            - vocal cord laceration
            - tracheal or esophageal perforation

Is that a Pneumothorax

    > Pneumothorax ex vacu - forms adjacent to atelectatic lobe, results from bronchial obstructions - do not treat with chest tube - relieve but fixing obstruction

0 Comments

    Archives

    August 2018
    February 2018
    January 2018
    December 2017
    October 2017
    September 2017
    August 2017
    July 2017
    June 2017
    May 2017
    April 2017
    March 2017
    February 2017
    January 2017
    December 2016
    November 2016
    October 2016
    September 2016
    August 2016
    July 2016
    June 2016
    May 2016
    April 2016
    March 2016
    February 2016
    January 2016
    December 2015
    November 2015
    October 2015
    September 2015
    August 2015
    July 2015
    June 2015
    May 2015
    April 2015
    March 2015
    February 2015
    January 2015
    December 2014
    November 2014
    October 2014
    September 2014
    August 2014
    July 2014
    June 2014
    May 2014
    April 2014
    March 2014
    February 2014
    January 2014
    December 2013
    November 2013
    October 2013
    September 2013
    August 2013
    July 2013

    Categories

    All
    Abdominal Pain
    Abdominal-pain
    Airway
    Back Pain
    Back Pain
    Bleeding
    Change-in-mental-status
    Chest Pain
    Dizziness
    Ecg
    Emboli
    Environmental
    Fever
    Gyn
    Headache
    Hypertension
    Infectious Disease
    Pain
    Pediatric Emergency
    Professionalism
    Psych
    Respiratory Distress
    Sepsis
    Shock
    Toxins
    Trauma
    Vomiting
    Weakness

    RSS Feed

    Tweets by @PedEMMorsels
Powered by Create your own unique website with customizable templates.
  • 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