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
    • 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

M&M - Dr. Bronner

4/3/2014

0 Comments

 
Picture
Myocardial Infarction in TTP
  1. Classic teaching for diagnosing TTP = "FAT  RN"
    • F - Fever
    • A - Microangiopathic Hemolytic Anemia (MAHA)
    • T - Thrombocytopenia
    • R - Renal Injury/Failure
    • N - Neurologic Involvement
  2. Newer thinking suggests you only need 2 of the above for a CLINICAL DIAGNOSIS
    • MAHA and Thrombocytopenia 
    • Peripheral Smear with schistocytes also helpful!
  3. Important to Dx early because treatment is best when started earliest - Plasma Exchange 
    • Call your hematologist early!
  4. What about the heart?
    • Lots of case reports, but few studies... suggest 15-40% of acute TTP have myocardial ischemia
    • If you suspect TTP get EKG, enzymes (TnI is best), and place patient on telemetry.
  5. FEVER is more suggestive of infection - THINK sepsis and DIC
  6. Consider revising your mnemonic... CAT RN
    • C - Cardiac Involvement
    • A - MAHA
    • T - Thrombocytopenia
    • R - Renal Injury
    • N - Neurologic Involvement



Penetrating Scrotal Trauma:
  1. What should we try to repair in the ED?
    • Only superficial wounds!
    • Anything that penetrated Dartos Fascia needs to be seen by urology
      • High incidence of damage to other testicle and cord structures


Diagnotic Error in Medical Decision Making
  1. Two of the major types of Error in our Clinical Thinking
    • AFFECTIVE - The notion that we may treat a patient differently because there is something about them or about the circumstance that evokes either a negative emotion or a positive emotion…
    • COGNITIVE - Errors based in problems with our analytical thinking... 
  2. Work to be aware of "Cognitive Dispositions"... Multifaceted, but two we deal with in EM regularly
    • COGNITIVE TRANSFER - Clinicians “pass off” biases when transferring the care of a patient to someone else.
    • DIAGNOSTIC MOMENTUM - Once the patient is given a diagnosis, it becomes difficult to remove. The diagnosis is then passed from provider, to provider, to provider…
  3. "Cognitive Forcing Strategies" can be employed to avoid these pitfalls, for example:
    • DIAGNOSTIC PAUSE - Was I comprehensive? Is there something I haven’t considered? What is the worst case scenario?Was my judgment affected by bias(es)?
  4. Many thanks to Dr, Michael Gibbs for his excellent slides on this topic... for more on metacognition in medicine check out Pat Croskerry's multiple works on the topic.  Here's a sample .mp3 from the NEJM.
0 Comments

Your comment will be posted after it is approved.


Leave a Reply.

    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
    • 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