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CMC Chief Case Conference - '15-'16 Chiefs

5/28/2015

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Sneaky Ectopic - Dr. Nichols

Picture
  • Don't let a beta HCG lull you to sleep, if your suspicion is high, get an ultrasound and/or discuss with OBGYN.
  • Beta HCG assays vary significaltly between labs, for accurate results try to maintain the same testing assay.
  • Anchoring is a dangerous bias that places you at high risk to miss key and potentially life-threatening diagnoses.
  • To avoid anchoring, be judicious about a "diagnostic pause" and await diagnosing patients until all information is available.


GIB and Aortic Graft - Dr. Beverly

Picture
  • History and physical is the foundation of medical decision making. Complete a good chart biopsy. Undress the patient fully. If not,  you may miss a crucial piece of information that will alter your decision making.
  • Aortoenteric fistula is a can't miss diagnosis. In a patient with a GI bleed and a known graft, this is your diagnosis until proven otherwise. 100% mortality if left untreated.
  • Consult vascular early of you suspect this diagnosis. Treatment involves early resuscitation and rapid operative intervention.


Pulmonary embolism + pleural effusion - Dr. West

Picture
  • Up to one half patients with PE’s with have a pleural effusion on CT, one third if just looking at CXR
  • Usually unilateral and small
  • Usually exudative
  • If a patient has a small pleural effusion and pleuritic chest pain, think pulmonary embolus


Traumatic Ptx, Be Kind - Dr. Robertson

Picture
  • Set your trauma rooms up ahead of time, know what to look for early in the patient's physical exam. 
  • Review the concepts of correct position and chest tube insertion techniques
  • Pigtail catheters are as efficacious as large bore chest tubes for traumatic pneumothorax
  • Keep an eye out for more data on Pigtails for blood in the chest. 
  • Large bore chest tubes remain standard of care for hemothorax, hemopneumothorax or concern for barotrauma in already vented patient's (even if pneumothorax is small). 

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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
    • 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