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M&M - Dr. Bronner

11/14/2013

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Picture
Case 1 - Lower extremity weakness
  • Generalized pain and BLE pain > numbness> weakness as well as urinary retention and epigastric pain; 2 weeks prior had vaginal hysterectomy with BSO.
  • Physical Exam - LLE objective wekaness
DDX - Transverse myelitis, EDH abscess, viral myeltitis, trauma ,degerenative, vascular, toxic metabllites
  • Admitted for MRI but, while admitted complained of chest pain > trop bumped, CTA showed aortic dissection
     > Learning points - DDimer cannot be used as a screening tool to rule out dissection
     > Stanford classification - A involves the aortic root, B is limited to the descending aorta
     > Prsenting sx of type B dissections- chest or back pain, abrupt onset of pain
     > Imaging - CXR - 56,5% are nl, TTE - usef for aortic root, CT best sensitivity and specificity

Therapy
  • BP/HR control - reduce shear stress:  SBP < 100 is goal, HR < 60;   beta blockers are first line
  • Type A = needs surgery, Typer B attempt medica control l
  • Before initial beta blocker, listen for aortic insufficiency and use ultrasound to evaluate for pericardial tamponade as these patients don't do well on beta blocker

Case 2 - Fatigue - dyspnea
  • Initially seeen in ambulatory area. Developed distress and moved to Major area. Called out as code sepsis.
a. Patient with worsening resp status and was started on heparin drip for possible PE.     
b. Admitted to hospital - heparin drip stopped and echo gotten - shows right heart strain
c. CTA showed massive Bilateral PEs

Predictors of Complications from PE
  • Troponin
  • Pulse ox
  • BNP
  • Echo findings
Massive PE = Unstable, sustained BP < 90 (for HTN and BP < 100)

Submassive PE - Rigth ventricle with dilitation and systolic dysfunction, CT - RV dysfunction, elevated BNP or troponin


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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