CMC Chief Case Conference - '15-'16 Chiefs

Sneaky Ectopic - Dr. Nichols

• 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

• 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

• 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

• 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). 

---